Provider First Line Business Practice Location Address:
3011 LEXINGTON 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:
40206-3005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-523-4358
Provider Business Practice Location Address Fax Number:
502-894-4426
Provider Enumeration Date:
09/14/2009