Provider First Line Business Practice Location Address:
520 SCHOOL WAY
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:
40214-1335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-206-2878
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/13/2016