Provider First Line Business Practice Location Address:
2106 BARDSTOWN RD
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:
40205-1916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-459-4647
Provider Business Practice Location Address Fax Number:
502-456-5705
Provider Enumeration Date:
09/13/2023