Provider First Line Business Practice Location Address:
724 SO 44TH STREET
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:
40211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-776-7656
Provider Business Practice Location Address Fax Number:
502-776-7640
Provider Enumeration Date:
01/26/2007