Provider First Line Business Practice Location Address:
231 N 26TH ST
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:
40212-1440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-616-2740
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2025