Provider First Line Business Practice Location Address:
8013 NEW LA GRANGE RD
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222-4700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-434-7050
Provider Business Practice Location Address Fax Number:
844-223-9413
Provider Enumeration Date:
12/23/2012