Provider First Line Business Practice Location Address:
254 MARKET PLACE DR
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:
40229-5450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-955-7246
Provider Business Practice Location Address Fax Number:
502-955-1508
Provider Enumeration Date:
09/16/2006