Individual
ANTONIO LYNE MCCORMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
107 CRANES ROOST CT, ELIZABETHTOWN, KY 42701-3650
(270) 765-2605
Mailing address
1109 REGENCY WAY APT 1, ELIZABETHTOWN, KY 42701-7134
(270) 307-4252
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
12/14/2020
Last updated
12/14/2020
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