Provider First Line Business Practice Location Address:
112 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLAN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40831-2106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-621-5134
Provider Business Practice Location Address Fax Number:
606-621-5074
Provider Enumeration Date:
04/26/2007