Provider First Line Business Practice Location Address: 
225 ABRAHAM FLEXNER WAY STE 700
    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: 
40202-3868
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
502-561-4263
    Provider Business Practice Location Address Fax Number: 
502-561-4288
    Provider Enumeration Date: 
09/01/2005