Provider First Line Business Practice Location Address:
22093 HIGHWAY 38
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLOSPLINT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40927-5813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-220-3724
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/03/2025