Provider First Line Business Practice Location Address:
129 SAINT MATTHEWS 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:
40207-3141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-797-8055
Provider Business Practice Location Address Fax Number:
502-409-8680
Provider Enumeration Date:
01/06/2011