Provider First Line Business Practice Location Address:
1620 EASTPOINT PKWY
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:
40223-4123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-501-3997
Provider Business Practice Location Address Fax Number:
866-567-3643
Provider Enumeration Date:
05/25/2011