Provider First Line Business Practice Location Address:
1003 OLD GREENSBURG RD
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:
42718-2571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-433-5806
Provider Business Practice Location Address Fax Number:
270-433-2443
Provider Enumeration Date:
05/04/2006