Provider First Line Business Practice Location Address:
10510 LAGRANGE ROAD
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:
40223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-253-7000
Provider Business Practice Location Address Fax Number:
503-253-7044
Provider Enumeration Date:
09/23/2010