Provider First Line Business Practice Location Address:
205 MOSER 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:
40223-3113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-245-5418
Provider Business Practice Location Address Fax Number:
502-245-5429
Provider Enumeration Date:
10/11/2006