Provider First Line Business Practice Location Address:
1013 DUPONT SQUARE NORTH
Provider Second Line Business Practice Location Address:
STE A
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:
502-896-6166
Provider Business Practice Location Address Fax Number:
502-896-6168
Provider Enumeration Date:
07/23/2006