Provider First Line Business Practice Location Address:
532 S 4TH 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:
40202-2553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-434-3122
Provider Business Practice Location Address Fax Number:
502-434-3123
Provider Enumeration Date:
09/03/2011