Provider First Line Business Practice Location Address:
70 UBERMONKEY LN
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:
42718-5217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-465-0060
Provider Business Practice Location Address Fax Number:
270-465-0134
Provider Enumeration Date:
06/27/2005