Provider First Line Business Practice Location Address:
2440 BARDSTOWN RD
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:
40205-2123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-459-3248
Provider Business Practice Location Address Fax Number:
502-454-3502
Provider Enumeration Date:
07/10/2006