Provider First Line Business Practice Location Address:
7943 BARDSTOWN 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:
40291-3437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-813-8080
Provider Business Practice Location Address Fax Number:
502-813-8081
Provider Enumeration Date:
12/27/2013