Provider First Line Business Practice Location Address:
3510 BARDSTOWN 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:
40218-4604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-379-4351
Provider Business Practice Location Address Fax Number:
502-459-9673
Provider Enumeration Date:
10/11/2005