Provider First Line Business Practice Location Address:
368 N HIGHWAY 27 STE 1
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:
42503-1712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-676-0045
Provider Business Practice Location Address Fax Number:
606-451-8371
Provider Enumeration Date:
03/23/2017