Provider First Line Business Practice Location Address:
3618 DIXIE HWY
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:
40216-4106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-447-7646
Provider Business Practice Location Address Fax Number:
502-448-6311
Provider Enumeration Date:
04/17/2007