Provider First Line Business Practice Location Address:
7304 DIXIE HWY
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:
40258-3722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-933-2225
Provider Business Practice Location Address Fax Number:
502-937-3783
Provider Enumeration Date:
03/10/2009