Provider First Line Business Practice Location Address:
10300 DIXIE HWY
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:
40272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-995-7775
Provider Business Practice Location Address Fax Number:
502-995-7765
Provider Enumeration Date:
09/12/2005