Provider First Line Business Practice Location Address:
9304 NEW LAGRANGE RD
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-272-0026
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2026