Provider First Line Business Practice Location Address:
5334 S 3RD ST
Provider Second Line Business Practice Location Address:
SOUTHEND MEDICAL CENTER
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40214-2612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-367-2288
Provider Business Practice Location Address Fax Number:
502-367-0108
Provider Enumeration Date:
08/10/2005