Provider First Line Business Practice Location Address:
250 E LIBERTY ST
Provider Second Line Business Practice Location Address:
310
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-587-6041
Provider Business Practice Location Address Fax Number:
502-589-0643
Provider Enumeration Date:
07/27/2006