Provider First Line Business Practice Location Address:
7421 OLD NORTH CHURCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40214-6011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-368-4119
Provider Business Practice Location Address Fax Number:
502-368-7945
Provider Enumeration Date:
05/14/2007