Provider First Line Business Practice Location Address:
7202 RIDGE CREEK 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:
40291-1870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-718-0381
Provider Business Practice Location Address Fax Number:
502-493-7352
Provider Enumeration Date:
09/27/2010