Provider First Line Business Practice Location Address:
8172 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMPBELLSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40011-0293
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-532-0099
Provider Business Practice Location Address Fax Number:
502-532-0096
Provider Enumeration Date:
05/14/2007