Provider First Line Business Practice Location Address:
110 HARDIN LN
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42503-3818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-679-7317
Provider Business Practice Location Address Fax Number:
606-679-0139
Provider Enumeration Date:
01/31/2007