Provider First Line Business Practice Location Address:
401 BOGLE ST., SUITE 102
Provider Second Line Business Practice Location Address:
INTRUST HEALTHCARE
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-676-0638
Provider Business Practice Location Address Fax Number:
606-679-1889
Provider Enumeration Date:
01/11/2008