Provider First Line Business Practice Location Address:
3026 POPLAR LEVEL 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:
40217-1301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-636-4929
Provider Business Practice Location Address Fax Number:
502-394-3629
Provider Enumeration Date:
04/10/2014