Provider First Line Business Practice Location Address:
589 MAIN ST
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:
41301-9755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-668-7030
Provider Business Practice Location Address Fax Number:
606-668-6825
Provider Enumeration Date:
07/22/2005