Provider First Line Business Practice Location Address:
1711 BARDSTOWN RD
Provider Second Line Business Practice Location Address:
SENECA OFFICE CTR SUITE 105
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-452-9197
Provider Business Practice Location Address Fax Number:
812-923-7386
Provider Enumeration Date:
05/11/2007