Provider First Line Business Practice Location Address:
1220 BARDSTOWN 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:
40204-1304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-736-3060
Provider Business Practice Location Address Fax Number:
502-451-5609
Provider Enumeration Date:
05/22/2007