Provider First Line Business Practice Location Address:
230 W BROADWAY
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:
40202-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-587-7788
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2007