Provider First Line Business Practice Location Address:
825 S 6TH 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:
40203-2123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-583-5636
Provider Business Practice Location Address Fax Number:
502-562-1235
Provider Enumeration Date:
02/19/2010