Provider First Line Business Practice Location Address:
8153 NEW LAGRANGE ROAD
Provider Second Line Business Practice Location Address:
#201
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222-8613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-738-1229
Provider Business Practice Location Address Fax Number:
502-410-2934
Provider Enumeration Date:
10/29/2020