Provider First Line Business Practice Location Address:
2111 W MUHAMMAD ALI BLVD
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:
40212-1761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-298-6121
Provider Business Practice Location Address Fax Number:
502-384-4492
Provider Enumeration Date:
05/20/2007