Provider First Line Business Practice Location Address:
1112 S. HWY. 27, STE. D, BOX #4
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:
42501-3503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-875-2125
Provider Business Practice Location Address Fax Number:
606-451-9624
Provider Enumeration Date:
11/08/2013