Provider First Line Business Practice Location Address:
5120 DIXIE HWY STE 105
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:
40216-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-448-8809
Provider Business Practice Location Address Fax Number:
502-448-8952
Provider Enumeration Date:
10/06/2011