Provider First Line Business Practice Location Address:
3703 TAYLORSVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-541-7661
Provider Business Practice Location Address Fax Number:
502-459-0629
Provider Enumeration Date:
09/09/2005