Provider First Line Business Practice Location Address:
1811 W MAIN ST
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:
40203-1254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-635-6400
Provider Business Practice Location Address Fax Number:
502-540-5323
Provider Enumeration Date:
04/13/2016