Provider First Line Business Practice Location Address:
801 BARRET AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40204-1747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-589-9310
Provider Business Practice Location Address Fax Number:
502-583-5560
Provider Enumeration Date:
05/26/2006