Provider First Line Business Practice Location Address:
719 W ASHLAND 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:
40215-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-366-4024
Provider Business Practice Location Address Fax Number:
502-366-4926
Provider Enumeration Date:
10/07/2006