Provider First Line Business Practice Location Address:
2809 N. HURSTBOURNE PKWY
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-423-5177
Provider Business Practice Location Address Fax Number:
502-423-5179
Provider Enumeration Date:
07/31/2006