Provider First Line Business Practice Location Address:
1611 BARDSTOWN 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:
40205-1209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-439-3994
Provider Business Practice Location Address Fax Number:
502-327-7266
Provider Enumeration Date:
07/24/2014