Provider First Line Business Practice Location Address:
990 BARRET AVE
Provider Second Line Business Practice Location Address:
#1
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40204-2063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-551-8504
Provider Business Practice Location Address Fax Number:
502-568-1299
Provider Enumeration Date:
05/16/2007