Provider First Line Business Practice Location Address:
215 CENTRAL AVE STE 200
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:
40208-1451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-852-7449
Provider Business Practice Location Address Fax Number:
502-852-1423
Provider Enumeration Date:
10/21/2011