Provider First Line Business Practice Location Address:
314 S WENZEL ST
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:
40204-1047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-387-1228
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/18/2024