Provider First Line Business Practice Location Address:
9304 NEW LAGRANGE RD STE 100
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:
40242-3671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-426-4511
Provider Business Practice Location Address Fax Number:
502-426-0529
Provider Enumeration Date:
03/05/2007