Provider First Line Business Practice Location Address:
49 KY 15 N
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:
41301-7284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-668-9841
Provider Business Practice Location Address Fax Number:
606-668-7730
Provider Enumeration Date:
12/07/2012