Provider First Line Business Practice Location Address:
284 MCCARTY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMPBELLSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40011-7577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-402-0897
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2026