Provider First Line Business Practice Location Address:
900 E MOUNT VERNON ST UNIT B
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:
42501-1228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-679-9227
Provider Business Practice Location Address Fax Number:
606-679-1358
Provider Enumeration Date:
04/15/2011