Provider First Line Business Practice Location Address:
12701 PLANTSIDE DR
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:
40299-6388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-302-6396
Provider Business Practice Location Address Fax Number:
502-470-7371
Provider Enumeration Date:
09/13/2018