Provider First Line Business Practice Location Address:
7501 NEW LAGRANGE 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:
40222-4815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-894-8595
Provider Business Practice Location Address Fax Number:
502-893-1636
Provider Enumeration Date:
02/20/2007