Provider First Line Business Practice Location Address:
500 MORTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAZARD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-436-2891
Provider Business Practice Location Address Fax Number:
606-436-0521
Provider Enumeration Date:
12/28/2005