Provider First Line Business Practice Location Address:
121 VILLAGE SQ
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:
40243-1420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-245-7491
Provider Business Practice Location Address Fax Number:
502-245-0581
Provider Enumeration Date:
06/27/2008