Provider First Line Business Practice Location Address:
202 PLUMMER STREET
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:
41301-7879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-668-7385
Provider Business Practice Location Address Fax Number:
606-668-7009
Provider Enumeration Date:
01/03/2014