Provider First Line Business Practice Location Address:
9113 LEESGATE 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:
40222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-500-4345
Provider Business Practice Location Address Fax Number:
502-614-7161
Provider Enumeration Date:
08/31/2011