Provider First Line Business Practice Location Address:
601 SOUTH FLOYD STREET
Provider Second Line Business Practice Location Address:
CHFB #470
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-6314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
150-262-9288
Provider Business Practice Location Address Fax Number:
150-262-9287
Provider Enumeration Date:
12/10/2015