Provider First Line Business Practice Location Address:
455SOUTH 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 950-C STARKS BLDG
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-2511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-587-6131
Provider Business Practice Location Address Fax Number:
502-587-9964
Provider Enumeration Date:
09/06/2006