Provider First Line Business Practice Location Address:
8521 LA GRANGE 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:
40242-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-709-5584
Provider Business Practice Location Address Fax Number:
502-709-5691
Provider Enumeration Date:
03/30/2022