Provider First Line Business Practice Location Address:
7984 NEW LA GRANGE 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:
40222-4718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-426-2777
Provider Business Practice Location Address Fax Number:
502-426-2776
Provider Enumeration Date:
01/12/2006