Provider First Line Business Practice Location Address:
10211 WESTPORT 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:
40241-2147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-339-0444
Provider Business Practice Location Address Fax Number:
502-339-1717
Provider Enumeration Date:
12/16/2005