Provider First Line Business Practice Location Address:
9116 KENLOCK DR
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:
40242-3328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-423-0010
Provider Business Practice Location Address Fax Number:
502-423-0010
Provider Enumeration Date:
01/29/2007