Provider First Line Business Practice Location Address:
1169 EASTERN PARKWAY
Provider Second Line Business Practice Location Address:
STE 411 MEDICAL ARTS BLDG
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-473-7028
Provider Business Practice Location Address Fax Number:
502-454-0666
Provider Enumeration Date:
02/15/2006