Provider First Line Business Practice Location Address:
6425 BARDSTOWN 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:
40291-3040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-762-0498
Provider Business Practice Location Address Fax Number:
502-762-0469
Provider Enumeration Date:
04/16/2013