Provider First Line Business Practice Location Address:
74 COMPREHENSIVE DR
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:
40831-1791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-573-7250
Provider Business Practice Location Address Fax Number:
606-573-6734
Provider Enumeration Date:
08/31/2006