Provider First Line Business Practice Location Address:
301 E. MUHAMMAD ALI BLVD
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:
40202-1594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-852-7665
Provider Business Practice Location Address Fax Number:
502-852-8550
Provider Enumeration Date:
11/21/2006