Provider First Line Business Practice Location Address:
647 W HIGHWAY 80
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:
42503-2897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-677-1922
Provider Business Practice Location Address Fax Number:
606-677-0382
Provider Enumeration Date:
01/10/2007