Provider First Line Business Practice Location Address:
10510 LA GRANGE RD
Provider Second Line Business Practice Location Address:
FLYNN BUILDING C/O CENTRAL STATE HOSPITAL
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40223-1277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-589-6000
Provider Business Practice Location Address Fax Number:
502-589-8771
Provider Enumeration Date:
10/06/2010