Provider First Line Business Practice Location Address:
1313 SAINT ANTHONY PL
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:
40204-1740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-587-7001
Provider Business Practice Location Address Fax Number:
502-587-0060
Provider Enumeration Date:
10/25/2006