Provider First Line Business Practice Location Address:
411 CRAB ORCHARD 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:
42503-1349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-485-4673
Provider Business Practice Location Address Fax Number:
606-485-4600
Provider Enumeration Date:
10/22/2021