Provider First Line Business Practice Location Address:
223 E MAGNOLIA 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:
40208-2025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-224-7067
Provider Business Practice Location Address Fax Number:
502-448-0701
Provider Enumeration Date:
12/29/2006