Provider First Line Business Practice Location Address:
2915 FRANKFORT AVE STE D
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:
40206-2682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-438-0506
Provider Business Practice Location Address Fax Number:
888-972-1943
Provider Enumeration Date:
02/07/2011