Provider First Line Business Practice Location Address:
399 CAMPBELLSVILLE BY PASS RD
Provider Second Line Business Practice Location Address:
STE 116
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:
270-469-4393
Provider Business Practice Location Address Fax Number:
270-469-1050
Provider Enumeration Date:
06/28/2005