Provider First Line Business Practice Location Address:
7980 NEW LAGRANGE ROAD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-412-3636
Provider Business Practice Location Address Fax Number:
502-412-2827
Provider Enumeration Date:
02/08/2012