Provider First Line Business Practice Location Address:
1100 E MARKET ST
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:
40206-1838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-596-1102
Provider Business Practice Location Address Fax Number:
502-596-1411
Provider Enumeration Date:
12/30/2011