Provider First Line Business Practice Location Address:
515 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:
40202-3388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-476-8119
Provider Business Practice Location Address Fax Number:
502-508-7997
Provider Enumeration Date:
09/12/2011