Provider First Line Business Practice Location Address:
AMBULATORY CARE BUILDING 550 S. JACKSON ST.,
Provider Second Line Business Practice Location Address:
3RD FLOOR, #A3K00
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-852-4277
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2023