Provider First Line Business Practice Location Address:
560B S. FOURTH STREET
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:
40202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-584-8505
Provider Business Practice Location Address Fax Number:
502-584-6412
Provider Enumeration Date:
01/24/2007