Provider First Line Business Practice Location Address:
9319 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:
40299-1737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-435-3833
Provider Business Practice Location Address Fax Number:
502-618-2609
Provider Enumeration Date:
03/14/2007