Provider First Line Business Practice Location Address:
195 BALLENGER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42629-7803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-292-3683
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2026