Provider First Line Business Practice Location Address:
7982 NEW LAGRANGE ROAD, SUITE 3
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:
40222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-657-4551
Provider Business Practice Location Address Fax Number:
502-919-9001
Provider Enumeration Date:
04/06/2015