Provider First Line Business Practice Location Address:
3717 TAYLORSVILLE 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:
40220-1333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-459-0225
Provider Business Practice Location Address Fax Number:
502-452-9079
Provider Enumeration Date:
09/27/2006