Provider First Line Business Practice Location Address:
6400 DUTCHMANS PKWY
Provider Second Line Business Practice Location Address:
STE 125
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-896-8700
Provider Business Practice Location Address Fax Number:
502-896-0813
Provider Enumeration Date:
08/05/2006