Provider First Line Business Practice Location Address:
296 MEDPARK DRIVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-677-0238
Provider Business Practice Location Address Fax Number:
606-679-2149
Provider Enumeration Date:
08/20/2006