Provider First Line Business Practice Location Address:
2225 W BROADWAY
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:
40211-1003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-589-8910
Provider Business Practice Location Address Fax Number:
502-772-2084
Provider Enumeration Date:
04/08/2008