Provider First Line Business Practice Location Address:
2860 N HIGHWAY 1247
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:
42503-4605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-872-2729
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2026