Provider First Line Business Practice Location Address:
148 TAYLOR RIDGE 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:
41701-6659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-487-8255
Provider Business Practice Location Address Fax Number:
606-487-8433
Provider Enumeration Date:
08/01/2006