Provider First Line Business Practice Location Address:
6470 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:
606-341-1339
Provider Business Practice Location Address Fax Number:
606-341-1340
Provider Enumeration Date:
08/20/2018