Provider First Line Business Practice Location Address:
120 SEARS AVE
Provider Second Line Business Practice Location Address:
STE. 202
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-5072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-893-8092
Provider Business Practice Location Address Fax Number:
502-895-2808
Provider Enumeration Date:
01/05/2007