Provider First Line Business Practice Location Address:
2400 EASTPOINT PKWY
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40223-4154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-253-6689
Provider Business Practice Location Address Fax Number:
502-253-6680
Provider Enumeration Date:
10/01/2010