Provider First Line Business Practice Location Address:
600 DR MARTIN LUTHER KING PL RM 464D
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:
40202-2239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-582-5921
Provider Business Practice Location Address Fax Number:
502-582-6490
Provider Enumeration Date:
06/03/2006