Provider First Line Business Practice Location Address:
9720 PARK PLAZA AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40241-2288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-425-9138
Provider Business Practice Location Address Fax Number:
502-425-9161
Provider Enumeration Date:
11/10/2007