Provider First Line Business Practice Location Address:
530 S JACKSON ST
Provider Second Line Business Practice Location Address:
DEPARTMENT OF EMERGENCY MEDICINE C1H17
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-852-5689
Provider Business Practice Location Address Fax Number:
502-852-4701
Provider Enumeration Date:
06/14/2005