Provider First Line Business Practice Location Address:
81 W HIGHWAY 80
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:
42503-2703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-341-1160
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2026