Provider First Line Business Practice Location Address:
2531 BLANKENBAKER PKWY
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:
40299-2465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-633-1007
Provider Business Practice Location Address Fax Number:
502-437-0624
Provider Enumeration Date:
04/06/2012