Provider First Line Business Practice Location Address:
1008 S SHELBY 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:
40203-3414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-741-9797
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2010