Provider First Line Business Practice Location Address:
2770 SLATE BRANCH RD
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:
42503-6369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-875-0996
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2009