Provider First Line Business Practice Location Address:
543 CAMP BRANCH ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEBBVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-429-6741
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2019