Provider First Line Business Practice Location Address:
4255 HAZELWOOD AVE
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:
40215-1210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-485-7141
Provider Business Practice Location Address Fax Number:
502-485-7145
Provider Enumeration Date:
10/29/2014