Provider First Line Business Practice Location Address:
2434 PARKDALE AVE
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:
40220-1047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-451-9317
Provider Business Practice Location Address Fax Number:
502-451-9317
Provider Enumeration Date:
11/03/2013