Provider First Line Business Practice Location Address:
444 S 1ST ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-238-2888
Provider Business Practice Location Address Fax Number:
502-238-2897
Provider Enumeration Date:
08/22/2006