Provider First Line Business Practice Location Address:
1238 E BROADWAY
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:
40204-1714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-587-7981
Provider Business Practice Location Address Fax Number:
502-584-2449
Provider Enumeration Date:
05/07/2007