Provider First Line Business Practice Location Address:
138 CAMPBELLSVILLE BYP
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
CAMPBELLSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42718-8843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-283-4638
Provider Business Practice Location Address Fax Number:
270-283-4639
Provider Enumeration Date:
09/02/2011