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:
41701-9485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-438-9937
Provider Business Practice Location Address Fax Number:
606-487-0396
Provider Enumeration Date:
04/10/2007