Provider First Line Business Practice Location Address:
5012 E MANSLICK RD
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:
40219-5165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-969-3277
Provider Business Practice Location Address Fax Number:
502-969-3270
Provider Enumeration Date:
12/29/2005