Provider First Line Business Practice Location Address:
5120 DIXIE HWY STE 105
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:
40216-1775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-282-3899
Provider Business Practice Location Address Fax Number:
812-282-4172
Provider Enumeration Date:
08/13/2021