Provider First Line Business Practice Location Address:
2226 HOLIDAY MANOR CTR STE 9
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:
40222-6407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-537-7870
Provider Business Practice Location Address Fax Number:
502-537-7871
Provider Enumeration Date:
09/07/2022