Provider First Line Business Practice Location Address:
3911 TAYLORSVILLE 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:
40220-1414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-454-4668
Provider Business Practice Location Address Fax Number:
502-451-4859
Provider Enumeration Date:
03/31/2012