Provider First Line Business Practice Location Address:
200 E CHESTNUT ST
Provider Second Line Business Practice Location Address:
SERVICE BLDG., STE. 303
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-629-5552
Provider Business Practice Location Address Fax Number:
502-629-3132
Provider Enumeration Date:
10/28/2008