Provider First Line Business Practice Location Address:
400 BLANKENBAKER PKWY
Provider Second Line Business Practice Location Address:
#200
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-244-6373
Provider Business Practice Location Address Fax Number:
502-244-9860
Provider Enumeration Date:
07/22/2006