Provider First Line Business Practice Location Address:
1800 W MUHAMMAD ALI BLVD # 2H
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:
40203-1560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-263-8338
Provider Business Practice Location Address Fax Number:
502-742-8535
Provider Enumeration Date:
03/13/2011