Provider First Line Business Practice Location Address:
3000 S 5TH 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:
40208-1312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-644-9162
Provider Business Practice Location Address Fax Number:
502-390-0330
Provider Enumeration Date:
11/20/2023