Provider First Line Business Practice Location Address:
530 S. JACKSON 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:
40202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-562-3436
Provider Business Practice Location Address Fax Number:
502-562-3437
Provider Enumeration Date:
01/11/2006