Provider First Line Business Practice Location Address:
2001 NEWBURG RD
Provider Second Line Business Practice Location Address:
KNIGHTS HALL
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40205-1863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-272-8379
Provider Business Practice Location Address Fax Number:
502-272-7341
Provider Enumeration Date:
12/07/2012