Provider First Line Business Practice Location Address: 
200 ABRAHAM FLEXNER WAY
    Provider Second Line Business Practice Location Address: 
ANESTHESIA DEPARTMENT
    Provider Business Practice Location Address City Name: 
LOUISVILLE
    Provider Business Practice Location Address State Name: 
KY
    Provider Business Practice Location Address Postal Code: 
40202-1886
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
502-587-4203
    Provider Business Practice Location Address Fax Number: 
502-587-4156
    Provider Enumeration Date: 
07/28/2015