Provider First Line Business Practice Location Address:
250 KENWOOD HILL ROAD
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:
40214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-445-8242
Provider Business Practice Location Address Fax Number:
502-364-4532
Provider Enumeration Date:
05/21/2007