Provider First Line Business Practice Location Address:
110 RICHIE LN.
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-676-9888
Provider Business Practice Location Address Fax Number:
606-676-9882
Provider Enumeration Date:
10/21/2008