Provider First Line Business Practice Location Address:
2033 N KY HIGHWAY 15
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:
41701-5621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-487-0744
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2007