Provider First Line Business Practice Location Address:
797 KY 15 SOUTH
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:
606-668-2273
Provider Business Practice Location Address Fax Number:
606-668-7699
Provider Enumeration Date:
10/19/2011