Provider First Line Business Practice Location Address:
2416 FRANKFORT AVE STE 3
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:
40206-2571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-893-1990
Provider Business Practice Location Address Fax Number:
502-893-3690
Provider Enumeration Date:
08/17/2009