Provider First Line Business Practice Location Address: 
220 ABRAHAM FLEXNER WAY FL 6
    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: 
40202-3826
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
502-582-7654
    Provider Business Practice Location Address Fax Number: 
502-588-7563
    Provider Enumeration Date: 
10/25/2006