Provider First Line Business Practice Location Address:
1850 TAYLOR AVE
Provider Second Line Business Practice Location Address:
SUITE 3B
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40213-1594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-458-4330
Provider Business Practice Location Address Fax Number:
502-458-4340
Provider Enumeration Date:
08/17/2005