Provider First Line Business Practice Location Address:
1536 STORY 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:
40206-1738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-589-1500
Provider Business Practice Location Address Fax Number:
502-589-1556
Provider Enumeration Date:
06/17/2009