Provider First Line Business Practice Location Address:
179 N BELLAIRE 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:
40206-2065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-380-5560
Provider Business Practice Location Address Fax Number:
502-491-4110
Provider Enumeration Date:
03/23/2007