Provider First Line Business Practice Location Address:
1599 CLEMENTSVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAMALIEL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42140-9208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-427-7255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2022