Provider First Line Business Practice Location Address:
4001 KRESGE WAY STE 330
Provider Second Line Business Practice Location Address:
BAPTIST EAST OFFICE PARK
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-897-2440
Provider Business Practice Location Address Fax Number:
502-897-2455
Provider Enumeration Date:
08/30/2006