Provider First Line Business Practice Location Address:
2355 POPLAR LEVEL RD
Provider Second Line Business Practice Location Address:
STE. 301
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40217-1395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-636-0406
Provider Business Practice Location Address Fax Number:
502-636-5137
Provider Enumeration Date:
06/06/2006