Provider First Line Business Practice Location Address:
5650 SOUTHERN PKWY
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:
40214-1207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-953-4700
Provider Business Practice Location Address Fax Number:
502-772-8189
Provider Enumeration Date:
08/08/2024