Provider First Line Business Practice Location Address:
341 BOGLE ST
Provider Second Line Business Practice Location Address:
STE. A
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42503-2815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-676-8186
Provider Business Practice Location Address Fax Number:
606-676-8956
Provider Enumeration Date:
02/15/2007