Provider First Line Business Practice Location Address:
1400 B BROWNS LANE
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:
40207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-721-7522
Provider Business Practice Location Address Fax Number:
502-721-7556
Provider Enumeration Date:
09/25/2006