Provider First Line Business Practice Location Address:
120 S HIGHWAY 27 STE 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:
42501-1784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-679-0155
Provider Business Practice Location Address Fax Number:
606-679-0088
Provider Enumeration Date:
01/22/2021