Provider First Line Business Practice Location Address:
3876 S HWY 27
Provider Second Line Business Practice Location Address:
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:
606-679-5328
Provider Business Practice Location Address Fax Number:
606-679-1972
Provider Enumeration Date:
10/19/2006