Provider First Line Business Practice Location Address:
7505 NEW LAGRANGE ROAD
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:
40222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-412-3232
Provider Business Practice Location Address Fax Number:
502-412-3233
Provider Enumeration Date:
11/18/2008