Provider First Line Business Practice Location Address:
7982 NEW LAGRANGE RD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222-4792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-426-6022
Provider Business Practice Location Address Fax Number:
502-426-9913
Provider Enumeration Date:
02/01/2007