Provider First Line Business Practice Location Address:
501 E UNIVERSITY DR
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:
42503-2467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-679-1123
Provider Business Practice Location Address Fax Number:
606-679-1438
Provider Enumeration Date:
01/22/2010