Provider First Line Business Practice Location Address:
400 BLANKENBAKER PKWY STE 200
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:
40243-1850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-554-4925
Provider Business Practice Location Address Fax Number:
502-244-9860
Provider Enumeration Date:
10/12/2006