Provider First Line Business Practice Location Address:
10101 TAYLORSVILLE 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:
40299-3622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-267-9099
Provider Business Practice Location Address Fax Number:
502-267-9019
Provider Enumeration Date:
07/02/2006