Provider First Line Business Practice Location Address:
9553 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:
40299-2734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-261-0400
Provider Business Practice Location Address Fax Number:
502-267-0487
Provider Enumeration Date:
07/29/2006