Provider First Line Business Practice Location Address:
1244 S 6TH ST
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:
40203-3012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-530-3788
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2023