Provider First Line Business Practice Location Address:
1022 SOUTH 6TH STREET
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:
40203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-589-6605
Provider Business Practice Location Address Fax Number:
502-585-0335
Provider Enumeration Date:
09/21/2016