Provider First Line Business Practice Location Address:
4965 US HIGHWAY 42 STE 1000
Provider Second Line Business Practice Location Address:
FENLEY OFFICE BUILDING
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222-6375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-272-4400
Provider Business Practice Location Address Fax Number:
502-272-4401
Provider Enumeration Date:
12/19/2013