Provider First Line Business Practice Location Address:
2125 S FLOYD STREET CARDINAL PARK
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:
40292-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-852-2160
Provider Business Practice Location Address Fax Number:
502-852-2497
Provider Enumeration Date:
04/09/2015