Provider First Line Business Practice Location Address:
173 SEARS AVE
Provider Second Line Business Practice Location Address:
STE 269
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-5059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-345-1520
Provider Business Practice Location Address Fax Number:
502-244-6994
Provider Enumeration Date:
07/05/2005