Provider First Line Business Practice Location Address:
720 BARRET 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:
40204-1750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-582-5555
Provider Business Practice Location Address Fax Number:
502-582-5556
Provider Enumeration Date:
08/01/2007