Provider First Line Business Practice Location Address:
676 S FLOYD 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:
40202-1840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-629-3114
Provider Business Practice Location Address Fax Number:
502-629-2443
Provider Enumeration Date:
05/23/2006