Provider First Line Business Practice Location Address:
1400 BROWNS LN
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-896-0036
Provider Business Practice Location Address Fax Number:
502-896-2786
Provider Enumeration Date:
05/22/2007