Provider First Line Business Practice Location Address:
126 N 42ND 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:
40212-2606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-389-7382
Provider Business Practice Location Address Fax Number:
502-822-1732
Provider Enumeration Date:
06/21/2018