Provider First Line Business Practice Location Address:
399 CAMPBELLSVILLE BYP STE 100
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:
42718-8831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-465-5782
Provider Business Practice Location Address Fax Number:
270-789-1463
Provider Enumeration Date:
07/10/2006