Provider First Line Business Practice Location Address:
18880 N US HIGHWAY 119
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40823-8106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-321-0663
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/29/2025