Provider First Line Business Practice Location Address:
300 E MOUNT VERNON 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:
42501-1331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-307-6336
Provider Business Practice Location Address Fax Number:
606-677-0412
Provider Enumeration Date:
01/10/2014