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