Provider First Line Business Practice Location Address:
411 E CHESTNUT 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:
40202-1713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-588-2201
Provider Business Practice Location Address Fax Number:
502-588-7776
Provider Enumeration Date:
02/18/2022