Provider First Line Business Practice Location Address:
1620 ARTHUR ST STE 119
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:
40208-2727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-208-8541
Provider Business Practice Location Address Fax Number:
800-934-1656
Provider Enumeration Date:
07/01/2024