Provider First Line Business Practice Location Address:
9420 BROWNSBORO 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:
40241-1118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-426-4264
Provider Business Practice Location Address Fax Number:
502-426-4221
Provider Enumeration Date:
06/14/2006