Provider First Line Business Practice Location Address:
211 WEST OAK STREET
Provider Second Line Business Practice Location Address:
TREYTON OAK TOWERS
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-589-3211
Provider Business Practice Location Address Fax Number:
502-589-7263
Provider Enumeration Date:
11/02/2005