Provider First Line Business Practice Location Address:
511 E UNIVERSITY DR
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:
42503-2467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-679-1574
Provider Business Practice Location Address Fax Number:
606-679-7020
Provider Enumeration Date:
02/20/2007