Provider First Line Business Practice Location Address:
102 MEDICAL CENTER DR STE B
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:
41701-9421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-487-7980
Provider Business Practice Location Address Fax Number:
606-487-7981
Provider Enumeration Date:
09/03/2021