Provider First Line Business Practice Location Address:
2478 S US HIGHWAY 421
Provider Second Line Business Practice Location Address:
WOODLAND PLAZA
Provider Business Practice Location Address City Name:
HARLAN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40831-1727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-573-7200
Provider Business Practice Location Address Fax Number:
606-574-0406
Provider Enumeration Date:
03/09/2007