Provider First Line Business Practice Location Address:
350 HOSPITAL WAY
Provider Second Line Business Practice Location Address:
SUITE 444, MEDICAL ARTS BUILDING
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42503-2872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-451-9500
Provider Business Practice Location Address Fax Number:
606-451-9501
Provider Enumeration Date:
01/08/2007