Provider First Line Business Practice Location Address:
247 SAUNDERS AVE
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:
40206-2850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-548-4913
Provider Business Practice Location Address Fax Number:
502-899-5105
Provider Enumeration Date:
02/18/2014