Provider First Line Business Practice Location Address:
832 S 6TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40203-2124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-690-2185
Provider Business Practice Location Address Fax Number:
502-690-2551
Provider Enumeration Date:
11/13/2008