Provider First Line Business Practice Location Address:
166 HIGHWAY 2491
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:
41301-0160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-668-8002
Provider Business Practice Location Address Fax Number:
606-668-8050
Provider Enumeration Date:
03/27/2007