Provider First Line Business Practice Location Address:
1050 E MARKET ST
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:
40206-1874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-596-1090
Provider Business Practice Location Address Fax Number:
502-596-1410
Provider Enumeration Date:
09/20/2010