Provider First Line Business Practice Location Address:
5338 S 3RD 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:
40214-2675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-366-4530
Provider Business Practice Location Address Fax Number:
502-366-4590
Provider Enumeration Date:
09/06/2005