Provider First Line Business Practice Location Address:
4121 DUTCHMANS LANE
Provider Second Line Business Practice Location Address:
SUITE 515 SUBURBAN MEDICAL PLAZA III
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-895-2440
Provider Business Practice Location Address Fax Number:
502-897-2311
Provider Enumeration Date:
08/07/2006