Provider First Line Business Practice Location Address:
444 S 1ST ST
Provider Second Line Business Practice Location Address:
201
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-238-2863
Provider Business Practice Location Address Fax Number:
502-238-2889
Provider Enumeration Date:
05/13/2006