Provider First Line Business Practice Location Address:
914 E. BROADWAY
Provider Second Line Business Practice Location Address:
2ND
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-589-1100
Provider Business Practice Location Address Fax Number:
502-589-8771
Provider Enumeration Date:
09/25/2006