Provider First Line Business Practice Location Address:
436 S 7TH ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40203-1981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-589-6167
Provider Business Practice Location Address Fax Number:
502-589-6170
Provider Enumeration Date:
07/14/2006