Provider First Line Business Practice Location Address:
210 W WOODLAWN 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:
40214-1922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-368-5529
Provider Business Practice Location Address Fax Number:
502-368-9883
Provider Enumeration Date:
06/17/2009