Provider First Line Business Practice Location Address:
939 E WASHINGTON ST # 1
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:
40206-1633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-648-0543
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2013