Provider First Line Business Practice Location Address:
409 W OAK 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:
40203-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-585-4254
Provider Business Practice Location Address Fax Number:
502-581-1921
Provider Enumeration Date:
05/02/2011