Provider First Line Business Practice Location Address: 
DEPARTMENT OF SURGERY; SCHOOL OF MEDICINE
    Provider Second Line Business Practice Location Address: 
UNIVERSITY OF LOUISVILLE
    Provider Business Practice Location Address City Name: 
LOUISVILLE
    Provider Business Practice Location Address State Name: 
KY
    Provider Business Practice Location Address Postal Code: 
40292-0001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
916-213-0622
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
11/14/2005