Provider First Line Business Practice Location Address:
546 LONGFIELD AVE STE 345
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:
40215-2930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-447-2222
Provider Business Practice Location Address Fax Number:
502-409-8042
Provider Enumeration Date:
02/21/2007