Provider First Line Business Practice Location Address:
3500 GOOD SAMARITAN WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSONTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40299-6117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-267-7403
Provider Business Practice Location Address Fax Number:
502-266-9001
Provider Enumeration Date:
07/11/2007