Provider First Line Business Practice Location Address:
4003 KRESGE WAY
Provider Second Line Business Practice Location Address:
STE 227
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-893-3342
Provider Business Practice Location Address Fax Number:
502-893-9575
Provider Enumeration Date:
07/26/2005