Provider First Line Business Practice Location Address:
1250 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:
42501-3525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-676-0485
Provider Business Practice Location Address Fax Number:
606-676-9625
Provider Enumeration Date:
05/24/2011