Provider First Line Business Practice Location Address:
220 ABRAHAM FLEXNER WAY
Provider Second Line Business Practice Location Address:
6TH FLOOR PSYCHOLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-3826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-582-7484
Provider Business Practice Location Address Fax Number:
502-582-7646
Provider Enumeration Date:
08/18/2005