Provider First Line Business Practice Location Address:
1901 CAMPUS PL
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:
40299-2308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-253-4911
Provider Business Practice Location Address Fax Number:
502-489-5750
Provider Enumeration Date:
11/10/2011