Provider First Line Business Practice Location Address:
3977 SEVENTH STREET ROAD
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:
40216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-449-1961
Provider Business Practice Location Address Fax Number:
502-449-9866
Provider Enumeration Date:
06/26/2007