Provider First Line Business Practice Location Address:
455 S 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 950C
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-2593
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-587-6131
Provider Business Practice Location Address Fax Number:
502-584-8600
Provider Enumeration Date:
06/24/2014