Provider First Line Business Practice Location Address:
3540 S HIGHWAY 27 STE 3
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:
42501-3124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-679-1815
Provider Business Practice Location Address Fax Number:
606-451-1631
Provider Enumeration Date:
01/13/2021