Provider First Line Business Practice Location Address:
1908 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
HAZARD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41701-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-439-2662
Provider Business Practice Location Address Fax Number:
606-439-0612
Provider Enumeration Date:
01/25/2008