Provider First Line Business Practice Location Address:
7901 3RD STREET RD
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:
40214-5571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-367-4360
Provider Business Practice Location Address Fax Number:
502-367-4257
Provider Enumeration Date:
06/07/2006