Provider First Line Business Practice Location Address:
9615 WHIPPS MILL 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:
40242-3644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-425-1146
Provider Business Practice Location Address Fax Number:
502-423-9668
Provider Enumeration Date:
10/26/2005