Provider First Line Business Practice Location Address:
1015 W CHESTNUT 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:
40203-2048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-584-2992
Provider Business Practice Location Address Fax Number:
502-584-3715
Provider Enumeration Date:
07/31/2012