Provider First Line Business Practice Location Address:
10207 GARLANREID PLACE
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:
40223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-699-0074
Provider Business Practice Location Address Fax Number:
513-584-3020
Provider Enumeration Date:
10/13/2006