Provider First Line Business Practice Location Address:
431 SLATE BRANCH 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:
42503-6104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-363-6433
Provider Business Practice Location Address Fax Number:
606-229-7266
Provider Enumeration Date:
03/08/2025