Provider First Line Business Practice Location Address:
8009 NEW LA GRANGE RD STE 8
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:
40222-4791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-385-4151
Provider Business Practice Location Address Fax Number:
502-385-6619
Provider Enumeration Date:
10/16/2024