Provider First Line Business Practice Location Address:
2000 DOUGLASS 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:
40205-1928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-459-4887
Provider Business Practice Location Address Fax Number:
502-452-1484
Provider Enumeration Date:
01/03/2007