Provider First Line Business Practice Location Address:
4601 HIGHWAY 55 SOUTH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42728-9286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-634-1582
Provider Business Practice Location Address Fax Number:
270-384-2686
Provider Enumeration Date:
05/04/2020