Provider First Line Business Practice Location Address:
5225 DIXIE HWY
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:
40216-1758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-447-8777
Provider Business Practice Location Address Fax Number:
502-448-8240
Provider Enumeration Date:
06/27/2018