Provider First Line Business Practice Location Address:
3900 S. DUPONT SQUARE STE A
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:
40207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-896-2131
Provider Business Practice Location Address Fax Number:
502-896-0345
Provider Enumeration Date:
08/11/2005