Provider First Line Business Practice Location Address:
155 BALL PARK RD
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:
40831-1755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-573-4400
Provider Business Practice Location Address Fax Number:
606-573-4777
Provider Enumeration Date:
07/27/2009