Provider First Line Business Practice Location Address:
2835 S HIGHWAY 27 STE 338
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:
42501-3063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-485-4090
Provider Business Practice Location Address Fax Number:
606-485-4093
Provider Enumeration Date:
01/08/2019