Provider First Line Business Practice Location Address:
295 CAMPBELLSVILLE BYP STE 1
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:
42718-7870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-465-4677
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2010