Provider First Line Business Practice Location Address:
129 KY 15 N
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:
606-436-5761
Provider Business Practice Location Address Fax Number:
606-436-5797
Provider Enumeration Date:
02/14/2007