Provider First Line Business Practice Location Address:
8801 SUMMIT RIDGE DR
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:
40241-1390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-836-3027
Provider Business Practice Location Address Fax Number:
888-366-7472
Provider Enumeration Date:
11/05/2012