Provider First Line Business Practice Location Address:
4009 POPLAR LEVEL RD
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:
40213-1523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-454-4106
Provider Business Practice Location Address Fax Number:
502-454-6328
Provider Enumeration Date:
07/10/2006