Provider First Line Business Practice Location Address:
200 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
SUITE #1P
Provider Business Practice Location Address City Name:
HAZARD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41701-9466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-439-6644
Provider Business Practice Location Address Fax Number:
606-439-0213
Provider Enumeration Date:
12/08/2006