Provider First Line Business Practice Location Address:
136 W MARKET 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:
40202-1332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-585-5325
Provider Business Practice Location Address Fax Number:
502-585-1137
Provider Enumeration Date:
02/25/2008