Provider First Line Business Practice Location Address:
350 LANGDON 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:
42503-2786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-278-5063
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2026