Provider First Line Business Practice Location Address:
8170 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:
40011-1467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-465-4003
Provider Business Practice Location Address Fax Number:
502-465-4008
Provider Enumeration Date:
07/17/2013