Provider First Line Business Practice Location Address:
324 DALE 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:
40229-3331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-713-1041
Provider Business Practice Location Address Fax Number:
502-277-1528
Provider Enumeration Date:
07/25/2011