Provider First Line Business Practice Location Address:
1924 DUKER 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:
40205-1002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-296-9897
Provider Business Practice Location Address Fax Number:
502-290-6017
Provider Enumeration Date:
12/02/2005