Provider First Line Business Practice Location Address:
1101 E WASHINGTON 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:
40206-1822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-546-6069
Provider Business Practice Location Address Fax Number:
866-873-8544
Provider Enumeration Date:
04/09/2010