Provider First Line Business Practice Location Address:
1848 FRANKFORT AVE UNIT R
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:
40206-3159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-552-3579
Provider Business Practice Location Address Fax Number:
812-941-6276
Provider Enumeration Date:
09/20/2021