Provider First Line Business Practice Location Address:
222 S 1ST ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-568-4800
Provider Business Practice Location Address Fax Number:
502-589-6882
Provider Enumeration Date:
07/14/2005