Provider First Line Business Practice Location Address:
2813 N HURSTBOURNE PKWY
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40223-1251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-326-0011
Provider Business Practice Location Address Fax Number:
502-326-0663
Provider Enumeration Date:
12/30/2006