Provider First Line Business Practice Location Address:
446 MOUNT HOLLY 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:
40206-2125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-897-1646
Provider Business Practice Location Address Fax Number:
502-897-7317
Provider Enumeration Date:
11/22/2020