Provider First Line Business Practice Location Address:
6400 DUTCHMANS PKWY
Provider Second Line Business Practice Location Address:
STE 135
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40205-3340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-895-5440
Provider Business Practice Location Address Fax Number:
502-895-5435
Provider Enumeration Date:
11/17/2006