Provider First Line Business Practice Location Address:
3710 CHAMBERLAIN LN STE A
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:
40241-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-995-4004
Provider Business Practice Location Address Fax Number:
502-933-5559
Provider Enumeration Date:
07/17/2020