Provider First Line Business Practice Location Address:
224 LANGDON 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:
42501-2342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-451-0771
Provider Business Practice Location Address Fax Number:
606-451-0780
Provider Enumeration Date:
09/07/2011