Provider First Line Business Practice Location Address:
120 E OAK 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:
40203-2704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-636-0400
Provider Business Practice Location Address Fax Number:
502-637-1812
Provider Enumeration Date:
09/22/2006