Provider First Line Business Practice Location Address:
214 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-653-1908
Provider Business Practice Location Address Fax Number:
502-371-0829
Provider Enumeration Date:
01/24/2014