Provider First Line Business Practice Location Address:
5316 S 3RD 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:
40214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-643-0560
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2018