Provider First Line Business Practice Location Address:
721 SOUTH PRESTON 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-589-9325
Provider Business Practice Location Address Fax Number:
502-585-5202
Provider Enumeration Date:
07/10/2006