Provider First Line Business Practice Location Address:
1850 S HURSTBOURNE PKWY STE 136
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:
40220-1644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-671-7707
Provider Business Practice Location Address Fax Number:
502-671-5500
Provider Enumeration Date:
02/14/2007