Provider First Line Business Practice Location Address:
501 S. PRESTON ST.
Provider Second Line Business Practice Location Address:
UNIVERSITY OF LOUISVILLE SCHOOL OF DENTISTRY DEPT OF EN
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-852-1318
Provider Business Practice Location Address Fax Number:
502-624-2966
Provider Enumeration Date:
11/29/2012