Provider First Line Business Practice Location Address:
303 N JOHNSON STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-668-7385
Provider Business Practice Location Address Fax Number:
606-464-0152
Provider Enumeration Date:
09/15/2023