Provider First Line Business Practice Location Address:
1452 E MAIN ST
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:
41701-2041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-487-0523
Provider Business Practice Location Address Fax Number:
606-487-0531
Provider Enumeration Date:
03/15/2017