Provider First Line Business Practice Location Address:
4025 POPLAR LEVEL RD
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:
40213-1523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-458-3274
Provider Business Practice Location Address Fax Number:
502-458-7897
Provider Enumeration Date:
02/19/2010