Provider First Line Business Practice Location Address:
101 CHAD ST
Provider Second Line Business Practice Location Address:
CLOVER FORK CLINIC
Provider Business Practice Location Address City Name:
EVARTS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40828-8200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-837-2108
Provider Business Practice Location Address Fax Number:
606-837-9389
Provider Enumeration Date:
06/11/2006