Provider First Line Business Practice Location Address:
1432 S SHELBY 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:
40217-1176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-634-0082
Provider Business Practice Location Address Fax Number:
502-636-0597
Provider Enumeration Date:
05/17/2007