Provider First Line Business Practice Location Address:
1587 COMBS RD.
Provider Second Line Business Practice Location Address:
SUITE 2
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:
606-910-0555
Provider Business Practice Location Address Fax Number:
606-910-0124
Provider Enumeration Date:
03/27/2011