Provider First Line Business Practice Location Address:
719 E CALDWELL 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:
40203-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-992-5460
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2026