Provider First Line Business Practice Location Address:
3101 FERN VALLEY RD
Provider Second Line Business Practice Location Address:
SUITE 13
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40213-3523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-938-7272
Provider Business Practice Location Address Fax Number:
502-968-7116
Provider Enumeration Date:
10/02/2006