Provider First Line Business Practice Location Address:
159 SAINT MATTHEWS AVE STE 3
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:
40207-3137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-721-0435
Provider Business Practice Location Address Fax Number:
502-721-0436
Provider Enumeration Date:
08/15/2006