Provider First Line Business Practice Location Address:
8153 NEW LAGRANGE RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222-8613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-654-6964
Provider Business Practice Location Address Fax Number:
502-709-6005
Provider Enumeration Date:
10/23/2021