Provider First Line Business Practice Location Address:
501 E BROADWAY STE 340
Provider Second Line Business Practice Location Address:
DEPT. OF PSYCHIATRY, UNIVERSITY OF LOUISVILLE
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-852-5395
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2007