Provider First Line Business Practice Location Address:
115 BLANKENBAKER PKWY
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:
40243-2098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-489-8480
Provider Business Practice Location Address Fax Number:
502-489-8482
Provider Enumeration Date:
01/31/2012