Provider First Line Business Practice Location Address:
240 HWY 15 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMPTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41301-0790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-693-0531
Provider Business Practice Location Address Fax Number:
606-693-0535
Provider Enumeration Date:
06/06/2007