Provider First Line Business Practice Location Address:
504 EDGEFOREST PL
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:
40245-5108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-387-7900
Provider Business Practice Location Address Fax Number:
502-893-9890
Provider Enumeration Date:
07/01/2008