Provider First Line Business Practice Location Address:
501 S. PRESTON ST.
Provider Second Line Business Practice Location Address:
SCHOOL OF DENTISTRY, SUITE 334
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40292-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-852-4171
Provider Business Practice Location Address Fax Number:
502-852-1973
Provider Enumeration Date:
05/11/2006