Provider First Line Business Practice Location Address:
1406 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:
42501-2916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-676-0022
Provider Business Practice Location Address Fax Number:
606-676-0333
Provider Enumeration Date:
07/27/2009