Provider First Line Business Practice Location Address:
7405A NEW LAGRANGE 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:
40222-4049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-425-6021
Provider Business Practice Location Address Fax Number:
502-412-0077
Provider Enumeration Date:
10/11/2005