Provider First Line Business Practice Location Address:
26 WOODLAND HLS
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:
40831-2562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
160-657-3455
Provider Business Practice Location Address Fax Number:
606-573-4402
Provider Enumeration Date:
09/07/2022