Provider First Line Business Practice Location Address:
8701 OLD BARDSTOWN RD STE B
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:
40291-4435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-618-2823
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2008