Provider First Line Business Practice Location Address:
107 WATTERSON TRAIL
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-245-5620
Provider Business Practice Location Address Fax Number:
502-244-7531
Provider Enumeration Date:
04/23/2007