Provider First Line Business Practice Location Address:
221 S PRESTON 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:
40202-1223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-589-1980
Provider Business Practice Location Address Fax Number:
502-589-1982
Provider Enumeration Date:
03/13/2007