Provider First Line Business Practice Location Address:
2226 HOLIDAY MANOR CTR STE 4
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:
40222-6407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-362-1460
Provider Business Practice Location Address Fax Number:
502-632-1458
Provider Enumeration Date:
01/21/2009