Provider First Line Business Practice Location Address:
9200 TAYLORSVILLE RD
Provider Second Line Business Practice Location Address:
111
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40299-1786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-671-0606
Provider Business Practice Location Address Fax Number:
502-671-1005
Provider Enumeration Date:
02/15/2007