Provider First Line Business Practice Location Address:
1488 OLD LEBANON RD STE C
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:
42718-3375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-299-2067
Provider Business Practice Location Address Fax Number:
270-299-2068
Provider Enumeration Date:
10/28/2013