Provider First Line Business Practice Location Address:
170 PRATHER RD
Provider Second Line Business Practice Location Address:
UNIT 1
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42503-6307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-875-7732
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2017