Provider First Line Business Practice Location Address:
250 E LIBERTY ST
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-587-0521
Provider Business Practice Location Address Fax Number:
502-587-3885
Provider Enumeration Date:
07/22/2006