Provider First Line Business Practice Location Address:
171 PENNSYLVANIA 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:
40206-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-939-4129
Provider Business Practice Location Address Fax Number:
502-894-9155
Provider Enumeration Date:
02/02/2007