Provider First Line Business Practice Location Address:
3516 FRANKFORT AVE
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:
40207-2561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-897-6453
Provider Business Practice Location Address Fax Number:
502-735-1222
Provider Enumeration Date:
10/07/2025