Provider First Line Business Practice Location Address:
941 N MAIN ST
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:
41701-1377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-439-4010
Provider Business Practice Location Address Fax Number:
606-439-0880
Provider Enumeration Date:
12/10/2009