Provider First Line Business Practice Location Address:
91 LITTLE GRAPEVINE CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAZARD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41701-7200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-435-2839
Provider Business Practice Location Address Fax Number:
606-436-5797
Provider Enumeration Date:
08/30/2006