Provider First Line Business Practice Location Address:
9115 LEESGATE RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222-5084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-429-8011
Provider Business Practice Location Address Fax Number:
502-429-6389
Provider Enumeration Date:
04/19/2006