Provider First Line Business Practice Location Address:
4825 S 3RD 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:
40214-2152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-366-6362
Provider Business Practice Location Address Fax Number:
502-368-8600
Provider Enumeration Date:
10/14/2005