Provider First Line Business Practice Location Address:
31 MAIN ST STE 1
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:
41301-9750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-668-9076
Provider Business Practice Location Address Fax Number:
606-668-6820
Provider Enumeration Date:
12/27/2012