Provider First Line Business Practice Location Address:
509 BARRET AVE
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:
40204-1139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-485-0722
Provider Business Practice Location Address Fax Number:
502-485-0792
Provider Enumeration Date:
08/10/2010