Provider First Line Business Practice Location Address:
2212 DUNDEE RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40205-1888
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-594-8326
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2012