Provider First Line Business Practice Location Address:
1548 CLARA 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:
40215-1919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-548-7151
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2024