Provider First Line Business Practice Location Address:
239 S 5TH ST
Provider Second Line Business Practice Location Address:
SUITE 1006
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-3213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-562-1213
Provider Business Practice Location Address Fax Number:
502-562-1214
Provider Enumeration Date:
10/31/2007