Provider First Line Business Practice Location Address:
4123 TAYLOR BLVD
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:
40215-2341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-333-0604
Provider Business Practice Location Address Fax Number:
502-290-9734
Provider Enumeration Date:
10/02/2006