Provider First Line Business Practice Location Address:
5316 S. 3RD STREET
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:
40214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-276-8778
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2008