Provider First Line Business Practice Location Address:
562 W FORTNEY BRANCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARTEMUS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40903-6012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-401-6595
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2026