Provider First Line Business Practice Location Address:
720 W BROADWAY
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:
40202-2216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-584-2059
Provider Business Practice Location Address Fax Number:
502-584-2835
Provider Enumeration Date:
09/28/2006