Provider First Line Business Practice Location Address:
1827 BARDSTOWN 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:
40205-1433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-396-8690
Provider Business Practice Location Address Fax Number:
502-451-6711
Provider Enumeration Date:
09/13/2013