Provider First Line Business Practice Location Address:
9127 FERN CREEK 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:
40291-2711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-239-0013
Provider Business Practice Location Address Fax Number:
502-239-0984
Provider Enumeration Date:
07/28/2006