Provider First Line Business Practice Location Address:
302 E BRECKINRIDGE 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:
40203-2328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-777-7708
Provider Business Practice Location Address Fax Number:
502-561-1113
Provider Enumeration Date:
07/16/2014