Provider First Line Business Practice Location Address:
971 SOUTH HIGHWAY 27
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-451-0239
Provider Business Practice Location Address Fax Number:
606-451-9640
Provider Enumeration Date:
07/28/2005