Provider First Line Business Practice Location Address:
201 MERIDIAN 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:
40207-3850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-893-0495
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2006