Provider First Line Business Practice Location Address:
257 COMBS RD
Provider Second Line Business Practice Location Address:
SUITE ONE
Provider Business Practice Location Address City Name:
HAZARD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41701-6851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-436-0091
Provider Business Practice Location Address Fax Number:
606-436-0069
Provider Enumeration Date:
06/07/2007