Provider First Line Business Practice Location Address:
120 SEARS AVE
Provider Second Line Business Practice Location Address:
STE 205
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-5072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-230-1637
Provider Business Practice Location Address Fax Number:
502-709-5117
Provider Enumeration Date:
06/10/2010