Provider First Line Business Practice Location Address:
4211 POPLAR LEVEL RD STE 205
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:
40213-1597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-473-7028
Provider Business Practice Location Address Fax Number:
502-688-6400
Provider Enumeration Date:
12/29/2006