Provider First Line Business Practice Location Address:
2515 7TH STREET RD
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:
40208-1070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-425-7659
Provider Business Practice Location Address Fax Number:
502-425-7658
Provider Enumeration Date:
03/25/2015