Provider First Line Business Practice Location Address:
2700 WOODLAND AVE
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:
40211-1755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-640-6137
Provider Business Practice Location Address Fax Number:
502-237-4092
Provider Enumeration Date:
12/16/2006