Provider First Line Business Practice Location Address:
4059 SOUTH 5TH 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:
40214-1656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-368-7224
Provider Business Practice Location Address Fax Number:
502-368-7224
Provider Enumeration Date:
05/04/2007