Provider First Line Business Practice Location Address:
300 MIDDLETOWN PARK PL STE A
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:
40243-2541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-254-3818
Provider Business Practice Location Address Fax Number:
502-254-3819
Provider Enumeration Date:
11/01/2007