Provider First Line Business Practice Location Address:
2314 FRANKLIN 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:
40216-2431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-407-2763
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/26/2024