Provider First Line Business Practice Location Address:
2007 S HIGHWAY 27
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42501-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-678-9953
Provider Business Practice Location Address Fax Number:
606-679-3445
Provider Enumeration Date:
05/06/2016