Provider First Line Business Practice Location Address:
712 E MUHAMMAD ALI BLVD
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:
40202-1643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-568-6972
Provider Business Practice Location Address Fax Number:
502-587-6683
Provider Enumeration Date:
05/18/2006