Provider First Line Business Practice Location Address:
UNIVERSITY OF LOUISVILLE SCHOOL OF DENTISTRY ROOM 148
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:
40292-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-852-5083
Provider Business Practice Location Address Fax Number:
502-852-5988
Provider Enumeration Date:
05/02/2021