Provider First Line Business Practice Location Address:
2032 ALTA AVE
Provider Second Line Business Practice Location Address:
#1
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40205-1102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-458-8549
Provider Business Practice Location Address Fax Number:
502-409-6931
Provider Enumeration Date:
07/03/2007