Provider First Line Business Practice Location Address:
315 E BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 1100 NORTON HEALTHCARE PAVILION
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-589-5544
Provider Business Practice Location Address Fax Number:
502-561-0040
Provider Enumeration Date:
07/15/2006