Provider First Line Business Practice Location Address:
2200 BROWNSBORO RD
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:
40206-2141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-894-9220
Provider Business Practice Location Address Fax Number:
502-897-9983
Provider Enumeration Date:
02/01/2020