Provider First Line Business Practice Location Address:
712 E MUHAMMAD ALI BLVD
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:
40202-1643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-569-1667
Provider Business Practice Location Address Fax Number:
502-569-6201
Provider Enumeration Date:
10/03/2006