Provider First Line Business Practice Location Address:
106 RAILROAD ST
Provider Second Line Business Practice Location Address:
BLDG. 2 SUITE 3
Provider Business Practice Location Address City Name:
HARLAN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40831-2320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-573-9944
Provider Business Practice Location Address Fax Number:
606-573-9995
Provider Enumeration Date:
02/15/2007