Provider First Line Business Practice Location Address:
2800 S FLOYD 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:
40292-1818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-852-8778
Provider Business Practice Location Address Fax Number:
502-852-7123
Provider Enumeration Date:
11/14/2013