Provider First Line Business Practice Location Address:
4418 MALCOLM AVE.
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:
40215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-363-7918
Provider Business Practice Location Address Fax Number:
502-363-7915
Provider Enumeration Date:
09/04/2008