Provider First Line Business Practice Location Address:
1502 S 7TH 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:
40208-1711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-912-8966
Provider Business Practice Location Address Fax Number:
502-371-5439
Provider Enumeration Date:
05/05/2014