Provider First Line Business Practice Location Address:
7200 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:
40258-3720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-935-4396
Provider Business Practice Location Address Fax Number:
502-935-5552
Provider Enumeration Date:
11/02/2006