Provider First Line Business Practice Location Address:
117 E KENTUCKY 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:
40203-2793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-584-3573
Provider Business Practice Location Address Fax Number:
502-515-3325
Provider Enumeration Date:
02/14/2021