Provider First Line Business Practice Location Address:
3401 DIXIE HWY
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:
40216-5015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-615-6542
Provider Business Practice Location Address Fax Number:
502-331-6062
Provider Enumeration Date:
12/04/2023