Provider First Line Business Practice Location Address:
222 S 1ST ST
Provider Second Line Business Practice Location Address:
102
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-5404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-723-1540
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2012