Provider First Line Business Practice Location Address:
30 MEDPARK SQUARE DR STE 2
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:
42503-1709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-510-4357
Provider Business Practice Location Address Fax Number:
866-460-2997
Provider Enumeration Date:
10/25/2022