Provider First Line Business Practice Location Address:
10001 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:
40299-3116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-290-6444
Provider Business Practice Location Address Fax Number:
502-290-5645
Provider Enumeration Date:
09/23/2005