Provider First Line Business Practice Location Address:
77 UNION ST
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:
42501-2409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-425-4787
Provider Business Practice Location Address Fax Number:
606-416-5966
Provider Enumeration Date:
10/24/2025