Provider First Line Business Practice Location Address:
3123 N KY HIGHWAY 15 STE 1
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:
41701-5632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-439-3399
Provider Business Practice Location Address Fax Number:
606-487-9280
Provider Enumeration Date:
03/25/2014