Provider First Line Business Practice Location Address:
832 S. 6TH STREET
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-568-1000
Provider Business Practice Location Address Fax Number:
502-736-9369
Provider Enumeration Date:
06/21/2012