Provider First Line Business Practice Location Address:
3418 FRANKFORT AVE
Provider Second Line Business Practice Location Address:
STE 345
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-891-8878
Provider Business Practice Location Address Fax Number:
502-891-8865
Provider Enumeration Date:
03/02/2006