Provider First Line Business Practice Location Address:
972 KY HIGHWAY 28
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:
41701-5746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-567-6612
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2026