Provider First Line Business Practice Location Address:
2120 NEWBURG ROAD
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-451-2474
Provider Business Practice Location Address Fax Number:
502-451-2474
Provider Enumeration Date:
11/13/2006