Provider First Line Business Practice Location Address:
3900 KRESGE WAY
Provider Second Line Business Practice Location Address:
STE 56
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-248-4789
Provider Business Practice Location Address Fax Number:
812-248-4773
Provider Enumeration Date:
12/29/2005