Provider First Line Business Practice Location Address:
650 S HIGHWAY 27 STE 3
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:
42501-3501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-677-9472
Provider Business Practice Location Address Fax Number:
606-677-0379
Provider Enumeration Date:
09/25/2009