Provider First Line Business Practice Location Address:
130 SOUTHERN SCHOOL 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:
42501-3223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-679-4782
Provider Business Practice Location Address Fax Number:
606-677-1746
Provider Enumeration Date:
10/14/2016