Provider First Line Business Practice Location Address:
1018 S 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40203-3221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-585-4320
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2006