Provider First Line Business Practice Location Address:
353 BOGLE ST
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:
42503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-678-2220
Provider Business Practice Location Address Fax Number:
606-451-0595
Provider Enumeration Date:
12/15/2005