Provider First Line Business Practice Location Address:
420 E CENTRAL ST
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:
40831-2372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-573-8700
Provider Business Practice Location Address Fax Number:
606-573-8701
Provider Enumeration Date:
08/26/2011