Provider First Line Business Practice Location Address:
2105 CRUMS LANE
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:
40216-4284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-589-8600
Provider Business Practice Location Address Fax Number:
502-589-8771
Provider Enumeration Date:
10/13/2010