Provider First Line Business Practice Location Address:
243 ROY CAMPBELL DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
HAZARD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-439-0447
Provider Business Practice Location Address Fax Number:
606-436-0408
Provider Enumeration Date:
02/15/2006