Provider First Line Business Practice Location Address:
1467 S 9TH 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:
40208-2254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-618-0835
Provider Business Practice Location Address Fax Number:
502-665-0500
Provider Enumeration Date:
02/21/2024