Provider First Line Business Practice Location Address:
122 OLD RUSH BRANCH RD
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:
42501-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-219-1805
Provider Business Practice Location Address Fax Number:
414-908-2690
Provider Enumeration Date:
07/03/2007