Provider First Line Business Practice Location Address:
3911 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:
40214-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-368-5575
Provider Business Practice Location Address Fax Number:
502-368-5596
Provider Enumeration Date:
07/06/2010