Provider First Line Business Practice Location Address:
9706 TAYLORSVILLE 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:
40299-2753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-267-0546
Provider Business Practice Location Address Fax Number:
502-267-7306
Provider Enumeration Date:
07/20/2006