Provider First Line Business Practice Location Address:
250 BELMONT AVENUE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-679-3277
Provider Business Practice Location Address Fax Number:
606-676-9350
Provider Enumeration Date:
06/25/2008