Provider First Line Business Practice Location Address:
2214 FRANKFORT AVE UPPR
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:
40206-2408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-743-6974
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2017