Provider First Line Business Practice Location Address:
3288 ILLINOIS AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-515-6621
Provider Business Practice Location Address Fax Number:
502-515-6620
Provider Enumeration Date:
03/23/2007