Provider First Line Business Practice Location Address:
1028 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:
40204-1667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-451-1221
Provider Business Practice Location Address Fax Number:
502-451-1334
Provider Enumeration Date:
06/11/2008