Provider First Line Business Practice Location Address:
971 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:
42501-3518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-999-1249
Provider Business Practice Location Address Fax Number:
855-656-7325
Provider Enumeration Date:
04/08/2008