Provider First Line Business Practice Location Address:
924 SOUTH SECOND STREET
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:
40203-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-589-9394
Provider Business Practice Location Address Fax Number:
502-589-9296
Provider Enumeration Date:
07/10/2006