Provider First Line Business Practice Location Address:
2226 RICHLAND AVE
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:
40218-3228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-345-3863
Provider Business Practice Location Address Fax Number:
502-805-0676
Provider Enumeration Date:
03/07/2008