Provider First Line Business Practice Location Address:
7400 NEW LA GRANGE RD
Provider Second Line Business Practice Location Address:
SUITE 315
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-423-1975
Provider Business Practice Location Address Fax Number:
502-423-9836
Provider Enumeration Date:
01/11/2007