Provider First Line Business Practice Location Address:
401 E. CHESTNUT ST.
Provider Second Line Business Practice Location Address:
STE. 550
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:
502-852-5401
Provider Business Practice Location Address Fax Number:
502-852-7602
Provider Enumeration Date:
10/14/2005