Provider First Line Business Practice Location Address:
6434 N PRESTON HWY
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:
40229-4488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-957-2149
Provider Business Practice Location Address Fax Number:
502-957-4738
Provider Enumeration Date:
12/12/2006