Provider First Line Business Practice Location Address:
3401 JEWELL AVE
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:
40212-2139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-772-7383
Provider Business Practice Location Address Fax Number:
502-772-7387
Provider Enumeration Date:
11/13/2008