Provider First Line Business Practice Location Address:
51 CARRIE LN
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:
40011-6218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-414-1114
Provider Business Practice Location Address Fax Number:
502-236-0555
Provider Enumeration Date:
09/21/2006