Provider First Line Business Practice Location Address:
411 E MUHAMMAD ALI BLVD
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:
40202-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-587-8673
Provider Business Practice Location Address Fax Number:
502-583-8057
Provider Enumeration Date:
12/04/2007