Provider First Line Business Practice Location Address:
6608 BARDSTOWN RD STE B
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:
40291-3084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-563-2961
Provider Business Practice Location Address Fax Number:
502-963-5848
Provider Enumeration Date:
01/29/2025