Provider First Line Business Practice Location Address:
635 S 3RD 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:
40202-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-561-1314
Provider Business Practice Location Address Fax Number:
502-561-1840
Provider Enumeration Date:
09/21/2011