Provider First Line Business Practice Location Address:
5129 DIXIE HWY
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40216-1727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-448-0931
Provider Business Practice Location Address Fax Number:
502-448-0918
Provider Enumeration Date:
04/19/2006