Provider First Line Business Practice Location Address:
4002 KRESGE WAY BLDG D
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:
40207-4661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-896-7612
Provider Business Practice Location Address Fax Number:
502-897-8238
Provider Enumeration Date:
02/16/2006