Provider First Line Business Practice Location Address:
234 AMY 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:
40212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-778-0001
Provider Business Practice Location Address Fax Number:
502-776-1133
Provider Enumeration Date:
08/15/2006