Provider First Line Business Practice Location Address:
530 SOUTH JACKSON STREET
Provider Second Line Business Practice Location Address:
PHARMACY DEPARTMENT - 712
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-562-4109
Provider Business Practice Location Address Fax Number:
502-562-3655
Provider Enumeration Date:
11/20/2006