Provider First Line Business Practice Location Address:
175 MEDPARK DR STE 1
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:
606-679-1761
Provider Business Practice Location Address Fax Number:
606-678-9071
Provider Enumeration Date:
05/22/2007