Provider First Line Business Practice Location Address:
2355 POPLAR LEVEL RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40217-1395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-636-7444
Provider Business Practice Location Address Fax Number:
502-636-7340
Provider Enumeration Date:
10/11/2005