Provider First Line Business Practice Location Address:
2120 HIGH WICKHAM PL
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40245-5902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-254-6097
Provider Business Practice Location Address Fax Number:
502-254-6098
Provider Enumeration Date:
11/15/2006