Provider First Line Business Practice Location Address:
680 S. FOURTH ST.
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:
40202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-337-2377
Provider Business Practice Location Address Fax Number:
217-337-4609
Provider Enumeration Date:
10/30/2012