Provider First Line Business Practice Location Address:
6455 BARDSTOWN 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:
40291-3069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-239-8221
Provider Business Practice Location Address Fax Number:
502-231-2976
Provider Enumeration Date:
08/31/2006