Provider First Line Business Practice Location Address:
8011 NEW LAGRANGE RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222-4781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-394-0402
Provider Business Practice Location Address Fax Number:
502-394-0480
Provider Enumeration Date:
03/19/2008