Provider First Line Business Practice Location Address:
1100 S 3RD 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:
40203-2902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-822-6286
Provider Business Practice Location Address Fax Number:
502-586-7147
Provider Enumeration Date:
06/05/2024