Provider First Line Business Practice Location Address:
250 E LIBERTY ST
Provider Second Line Business Practice Location Address:
714 JB HAILE MD
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-582-2830
Provider Business Practice Location Address Fax Number:
502-582-2610
Provider Enumeration Date:
09/21/2006