Provider First Line Business Practice Location Address:
720 E BROADWAY
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:
40202-1712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-584-3021
Provider Business Practice Location Address Fax Number:
502-589-7319
Provider Enumeration Date:
08/31/2006