Provider First Line Business Practice Location Address:
2137 DIXIE HWY
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:
40210-2242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-414-7788
Provider Business Practice Location Address Fax Number:
859-757-2042
Provider Enumeration Date:
08/09/2021