Provider First Line Business Practice Location Address:
2220 HIGHLAND AVE
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:
40204-2335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-386-3367
Provider Business Practice Location Address Fax Number:
502-742-2889
Provider Enumeration Date:
01/28/2011