Provider First Line Business Practice Location Address:
3924 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:
40218-2610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-493-2512
Provider Business Practice Location Address Fax Number:
502-493-2513
Provider Enumeration Date:
03/12/2019