Provider First Line Business Practice Location Address:
11585 PAINT LICK SPUR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAINT LICK
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40461-8370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-925-4610
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/21/2023