Provider First Line Business Practice Location Address:
1931 FRANKFORT AVE
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:
40206-2026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-893-4020
Provider Business Practice Location Address Fax Number:
502-893-1330
Provider Enumeration Date:
02/05/2007