Provider First Line Business Practice Location Address:
1867 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:
40206-3148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-897-1583
Provider Business Practice Location Address Fax Number:
502-897-2994
Provider Enumeration Date:
07/13/2010