Provider First Line Business Practice Location Address:
5524 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:
40291-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-491-9200
Provider Business Practice Location Address Fax Number:
502-491-9146
Provider Enumeration Date:
11/20/2023