Provider First Line Business Practice Location Address:
225 W 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:
40203-2219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-637-4361
Provider Business Practice Location Address Fax Number:
502-587-7145
Provider Enumeration Date:
03/31/2016