Provider First Line Business Practice Location Address:
800 SOUTH PRESTON 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:
40203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-568-4647
Provider Business Practice Location Address Fax Number:
855-894-2071
Provider Enumeration Date:
12/10/2012