Provider First Line Business Practice Location Address:
3332 NEWBURG ROAD
Provider Second Line Business Practice Location Address:
VAN HOOSE EDUCATION CENTER 4TH FLOOR
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40218-2414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-485-8500
Provider Business Practice Location Address Fax Number:
502-485-3776
Provider Enumeration Date:
01/30/2007