Provider First Line Business Practice Location Address:
3812 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:
40220-1304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-451-9949
Provider Business Practice Location Address Fax Number:
502-451-4553
Provider Enumeration Date:
06/11/2012