Provider First Line Business Practice Location Address:
252 WHITTINGTON PKWY
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:
40222-4904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
24-237-2465
Provider Business Practice Location Address Fax Number:
24-267-2475
Provider Enumeration Date:
12/27/2006