Provider First Line Business Mailing Address: 
550 S. JACKSON STREET
    Provider Second Line Business Mailing Address: 
DEPARTMENT OF SURGERY, 2ND FLOOR ACB
    Provider Business Mailing Address City Name: 
LOUISVILLE
    Provider Business Mailing Address State Name: 
KY
    Provider Business Mailing Address Postal Code: 
40202-1702
    Provider Business Mailing Address Country Code: 
US
    Provider Business Mailing Address Telephone Number: 
    Provider Business Mailing Address Fax Number: