Provider First Line Business Practice Location Address:
127 OLD MONTICELLO 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:
42501-2357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-677-1166
Provider Business Practice Location Address Fax Number:
606-451-3386
Provider Enumeration Date:
08/05/2008