Provider First Line Business Practice Location Address:
170 DR ARLA WAY STE 1
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:
40229-5427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-955-4889
Provider Business Practice Location Address Fax Number:
502-957-1201
Provider Enumeration Date:
10/11/2006