Provider First Line Business Practice Location Address:
332 E OAK ST
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:
40203-2728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-636-3778
Provider Business Practice Location Address Fax Number:
502-636-3779
Provider Enumeration Date:
10/07/2006