Provider First Line Business Practice Location Address:
546 PARKERS MILL RD
Provider Second Line Business Practice Location Address:
UNIT B
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:
606-425-4051
Provider Business Practice Location Address Fax Number:
606-425-4177
Provider Enumeration Date:
10/23/2023