Provider First Line Business Practice Location Address:
8011 NEW LAGRANGE ROAD
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222-4707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-212-1031
Provider Business Practice Location Address Fax Number:
502-470-7250
Provider Enumeration Date:
01/03/2007