Provider First Line Business Practice Location Address:
5314 BILLTOWN 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:
40299-1229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-671-9681
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2025