Provider First Line Business Practice Location Address:
4018 W MARKET ST
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:
40212-2541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-485-7230
Provider Business Practice Location Address Fax Number:
502-485-7250
Provider Enumeration Date:
02/23/2007