Provider First Line Business Practice Location Address:
2239 1/2 TALBOTT 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:
40205-2271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-208-8794
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2012