Provider First Line Business Practice Location Address:
11909 LOCUST 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:
40243-1412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-244-8127
Provider Business Practice Location Address Fax Number:
502-244-8127
Provider Enumeration Date:
08/05/2009