Provider First Line Business Practice Location Address:
4544 TAYLORSVILLE 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:
40220-3528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-499-0442
Provider Business Practice Location Address Fax Number:
502-499-0434
Provider Enumeration Date:
07/28/2006