Provider First Line Business Practice Location Address:
200 MEDICAL CENTER DRIVE
Provider Second Line Business Practice Location Address:
SUITE 3L
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:
606-439-1815
Provider Business Practice Location Address Fax Number:
606-436-5021
Provider Enumeration Date:
10/26/2006