Provider First Line Business Practice Location Address:
3430 NEWBURG RD
Provider Second Line Business Practice Location Address:
STE 153
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-459-8127
Provider Business Practice Location Address Fax Number:
502-459-8620
Provider Enumeration Date:
09/29/2006