Provider First Line Business Practice Location Address:
82 HIGH POINT DR
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:
42501-3005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-678-2034
Provider Business Practice Location Address Fax Number:
606-678-2004
Provider Enumeration Date:
08/22/2007