Provider First Line Business Practice Location Address:
3828 BARDSTOWN RD
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:
40218-1527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-459-4900
Provider Business Practice Location Address Fax Number:
502-454-0591
Provider Enumeration Date:
10/03/2006