Provider First Line Business Practice Location Address:
101S. 5TH ST; 11TH FLOOR - NATIONAL CITY TOWER
Provider Second Line Business Practice Location Address:
C/O HUMANA, INC
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:
480-256-0703
Provider Business Practice Location Address Fax Number:
502-301-5506
Provider Enumeration Date:
05/07/2007