Provider First Line Business Practice Location Address:
3701 FRANKFORT AVE
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:
40207-2556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-259-9627
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2020