Provider First Line Business Practice Location Address:
1410 LONG RUN 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:
40245-4334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-244-8011
Provider Business Practice Location Address Fax Number:
502-244-6631
Provider Enumeration Date:
01/15/2009