Provider First Line Business Practice Location Address:
1138 S 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:
42501-3523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-677-2006
Provider Business Practice Location Address Fax Number:
606-677-1779
Provider Enumeration Date:
12/18/2015