Provider First Line Business Practice Location Address:
550 S JACKSON ST
Provider Second Line Business Practice Location Address:
ACB - 2ND FL
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40292-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-852-7660
Provider Business Practice Location Address Fax Number:
502-852-8551
Provider Enumeration Date:
02/12/2007