Provider First Line Business Practice Location Address:
90 B ROGER COMBS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HINDMAN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-785-5700
Provider Business Practice Location Address Fax Number:
606-785-4004
Provider Enumeration Date:
09/14/2011