Provider First Line Business Practice Location Address:
2120 NEWBURG RD
Provider Second Line Business Practice Location Address:
NCAH 116
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40205-1873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-272-7969
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2015