Provider First Line Business Practice Location Address:
1340 S HIGHWAY 27 STE C
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:
42501-2900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-676-0123
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2023