Provider First Line Business Practice Location Address:
1866 CAMPUS PLACE
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:
40219-1922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-637-5474
Provider Business Practice Location Address Fax Number:
502-634-0919
Provider Enumeration Date:
08/13/2008