Provider First Line Business Practice Location Address:
2239 BARDSTOWN RD
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:
40205-1917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-454-0414
Provider Business Practice Location Address Fax Number:
502-454-6262
Provider Enumeration Date:
01/24/2018