Provider First Line Business Practice Location Address:
1169 EASTERN PARKWAY
Provider Second Line Business Practice Location Address:
MEDICAL ARTS BLDG, SUITE 3438
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-265-5939
Provider Business Practice Location Address Fax Number:
502-473-6911
Provider Enumeration Date:
05/08/2009