Provider First Line Business Practice Location Address:
806 ULRICH AVENUE
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:
40219-1846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-966-0823
Provider Business Practice Location Address Fax Number:
502-966-0824
Provider Enumeration Date:
09/20/2006