Provider First Line Business Practice Location Address:
200 MEDICAL CENTER DR STE 3O
Provider Second Line Business Practice Location Address:
PROFESSIONAL OFFICE BUILDING
Provider Business Practice Location Address City Name:
HAZARD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41701-9478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-439-2239
Provider Business Practice Location Address Fax Number:
606-439-3096
Provider Enumeration Date:
06/19/2007