Provider First Line Business Practice Location Address:
11213 BEARCAMP 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:
40272-1913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-338-1370
Provider Business Practice Location Address Fax Number:
502-337-3149
Provider Enumeration Date:
02/02/2009