Provider First Line Business Practice Location Address:
6610 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:
40291-3045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-233-8048
Provider Business Practice Location Address Fax Number:
502-373-1288
Provider Enumeration Date:
07/22/2014