Provider First Line Business Practice Location Address:
6801 DIXIE HWY
Provider Second Line Business Practice Location Address:
SUITE127
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40258-3913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-935-5633
Provider Business Practice Location Address Fax Number:
502-935-5706
Provider Enumeration Date:
11/22/2005