Provider First Line Business Practice Location Address:
8000 LOTTS CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAZARD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41701-9046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-233-2812
Provider Business Practice Location Address Fax Number:
606-233-2812
Provider Enumeration Date:
04/18/2018