Provider First Line Business Practice Location Address:
592 KY 15 SOUTH
Provider Second Line Business Practice Location Address:
SUITE 5
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:
606-668-7393
Provider Business Practice Location Address Fax Number:
866-718-4137
Provider Enumeration Date:
01/27/2016