Provider First Line Business Practice Location Address:
8149 NEW LAGRANGE RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222-4689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-931-7490
Provider Business Practice Location Address Fax Number:
502-244-2725
Provider Enumeration Date:
12/11/2006