Provider First Line Business Practice Location Address:
758 S 1ST ST
Provider Second Line Business Practice Location Address:
CENTER ONE
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-2023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-589-8959
Provider Business Practice Location Address Fax Number:
502-589-8949
Provider Enumeration Date:
11/25/2013