Provider First Line Business Practice Location Address:
605 E MAPLE ST
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:
42718-1830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-789-0033
Provider Business Practice Location Address Fax Number:
270-789-0038
Provider Enumeration Date:
01/09/2012