Provider First Line Business Practice Location Address:
118 S 1ST ST
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:
40831-2318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-574-9000
Provider Business Practice Location Address Fax Number:
606-574-9001
Provider Enumeration Date:
06/28/2007