Provider First Line Business Practice Location Address:
444 S 1ST ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-583-6647
Provider Business Practice Location Address Fax Number:
502-585-4824
Provider Enumeration Date:
09/20/2005