Provider First Line Business Practice Location Address:
9312 NEW LA GRANGE 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:
40242-3619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-208-7050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2018