Provider First Line Business Practice Location Address:
2418 GLENMARY 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:
40204-2103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-767-7553
Provider Business Practice Location Address Fax Number:
502-451-1131
Provider Enumeration Date:
09/29/2006