Provider First Line Business Practice Location Address:
5601 S 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-361-8801
Provider Business Practice Location Address Fax Number:
502-366-8655
Provider Enumeration Date:
01/04/2007