Provider First Line Business Practice Location Address:
490 WILLIAMS BRANCH RD
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:
41701-7055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-378-2215
Provider Business Practice Location Address Fax Number:
606-378-2223
Provider Enumeration Date:
06/20/2006