Provider First Line Business Practice Location Address:
200 E 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:
40202-2008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-568-4864
Provider Business Practice Location Address Fax Number:
502-568-9077
Provider Enumeration Date:
08/30/2011