Provider First Line Business Practice Location Address:
4 LORUP AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT WRIGHT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41011-3622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-816-6566
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2026