Provider First Line Business Practice Location Address:
533 E KENTUCKY 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:
40203-2525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-588-6085
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2023