Provider First Line Business Practice Location Address:
210 BLACK GOLD BLVD STE 210
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:
41701-2620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-487-7000
Provider Business Practice Location Address Fax Number:
606-487-7022
Provider Enumeration Date:
01/14/2008