Provider First Line Business Practice Location Address:
931 SOUTH 3RD 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-561-6431
Provider Business Practice Location Address Fax Number:
502-561-6432
Provider Enumeration Date:
07/26/2011