Provider First Line Business Practice Location Address:
3715 BARDSTOWN RD
Provider Second Line Business Practice Location Address:
SUITE 415
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40218-2244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-458-4530
Provider Business Practice Location Address Fax Number:
502-458-2070
Provider Enumeration Date:
02/23/2007