Provider First Line Business Practice Location Address:
1015 S 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40203-3207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-882-2541
Provider Business Practice Location Address Fax Number:
502-584-2432
Provider Enumeration Date:
06/02/2016