Provider First Line Business Practice Location Address:
1545 CAMPBELLSVILLE RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42728-2262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-385-9600
Provider Business Practice Location Address Fax Number:
270-385-9631
Provider Enumeration Date:
08/14/2006