Provider First Line Business Practice Location Address:
136 S COLUMBIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMPBELLSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42718-1339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-465-4162
Provider Business Practice Location Address Fax Number:
270-465-3918
Provider Enumeration Date:
01/08/2007