Provider First Line Business Practice Location Address:
1227 GOSS 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:
40217-1239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-636-1200
Provider Business Practice Location Address Fax Number:
502-636-0351
Provider Enumeration Date:
02/23/2007