Provider First Line Business Practice Location Address:
PO BOX 62
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST BERNSTADT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40729-0062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-648-6805
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2026