Provider First Line Business Practice Location Address:
1228 E BRECKINRIDGE ST
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:
40204-2037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-471-9538
Provider Business Practice Location Address Fax Number:
502-895-8450
Provider Enumeration Date:
10/21/2008