Provider First Line Business Practice Location Address:
1169 EASTERN PKWY 2310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUSIVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-456-2783
Provider Business Practice Location Address Fax Number:
502-456-2728
Provider Enumeration Date:
10/03/2006