Provider First Line Business Practice Location Address:
8013 NEW LAGRANGE RD.
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222-4700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-551-0526
Provider Business Practice Location Address Fax Number:
502-429-6562
Provider Enumeration Date:
05/16/2007