Provider First Line Business Practice Location Address:
1072 BARDSTOWN ROAD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-585-5400
Provider Business Practice Location Address Fax Number:
502-585-9592
Provider Enumeration Date:
01/17/2007