Provider First Line Business Practice Location Address:
120 TRADEPARK DR
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42503-3454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-679-7778
Provider Business Practice Location Address Fax Number:
606-451-1814
Provider Enumeration Date:
12/01/2005