Provider First Line Business Practice Location Address:
3999 DUTCHMANS LANE
Provider Second Line Business Practice Location Address:
MEDICAL PLAZA 1 STE 6
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-394-1999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2019