Provider First Line Business Practice Location Address:
310 E BROADWAY STE 100
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:
40202-1745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-245-0002
Provider Business Practice Location Address Fax Number:
502-742-0485
Provider Enumeration Date:
07/11/2005