Provider First Line Business Practice Location Address:
4950 NORTON HEALTHCARE BLVD STE 208
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:
40241-2847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-614-4179
Provider Business Practice Location Address Fax Number:
502-614-4450
Provider Enumeration Date:
10/03/2008