Provider First Line Business Practice Location Address:
1169 EASTERN PKWY
Provider Second Line Business Practice Location Address:
STE 1211
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-896-8700
Provider Business Practice Location Address Fax Number:
502-896-0813
Provider Enumeration Date:
09/13/2006