Provider First Line Business Practice Location Address:
727 SPECKMAN 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:
40243-1876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-250-2003
Provider Business Practice Location Address Fax Number:
502-250-2004
Provider Enumeration Date:
10/17/2006