Provider First Line Business Practice Location Address:
305 COLLEGE ST
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:
42501-1311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-679-5466
Provider Business Practice Location Address Fax Number:
606-678-0864
Provider Enumeration Date:
01/05/2007