Provider First Line Business Practice Location Address:
173 SEARS AVE
Provider Second Line Business Practice Location Address:
#181
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-5059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-893-0050
Provider Business Practice Location Address Fax Number:
502-893-0049
Provider Enumeration Date:
01/20/2007