Provider First Line Business Practice Location Address:
8013 NEW LAGRANGE RD
Provider Second Line Business Practice Location Address:
STE 3
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:
502-426-1047
Provider Business Practice Location Address Fax Number:
502-426-1059
Provider Enumeration Date:
02/21/2007