Provider First Line Business Practice Location Address:
545 S 2ND 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:
40202-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-572-2608
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2018