Provider First Line Business Practice Location Address:
6503 DIXIE HWY
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:
40258-3907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-447-4864
Provider Business Practice Location Address Fax Number:
502-449-4505
Provider Enumeration Date:
11/09/2007