Provider First Line Business Practice Location Address:
8149 NEW LA GRANGE RD
Provider Second Line Business Practice Location Address:
SUITE 101
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:
502-412-6444
Provider Business Practice Location Address Fax Number:
502-412-6444
Provider Enumeration Date:
01/05/2010