Provider First Line Business Practice Location Address:
243 UNION ST
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:
42501-2412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-425-4665
Provider Business Practice Location Address Fax Number:
606-678-0333
Provider Enumeration Date:
02/03/2021