Provider First Line Business Practice Location Address:
614 E CHESTNUT ST
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:
40202-1604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-589-0900
Provider Business Practice Location Address Fax Number:
502-589-9928
Provider Enumeration Date:
02/13/2006