Provider First Line Business Practice Location Address:
801 BARRET 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:
40204-1747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-582-2004
Provider Business Practice Location Address Fax Number:
502-582-2032
Provider Enumeration Date:
03/19/2014