Provider First Line Business Practice Location Address:
2441 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:
42501-2935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-677-4068
Provider Business Practice Location Address Fax Number:
606-677-4147
Provider Enumeration Date:
02/20/2012