Provider First Line Business Practice Location Address:
13117 EASTPOINT PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40223-4193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-244-1212
Provider Business Practice Location Address Fax Number:
502-244-1256
Provider Enumeration Date:
02/13/2015