Provider First Line Business Practice Location Address:
279 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:
41701-1973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-487-9505
Provider Business Practice Location Address Fax Number:
606-436-0071
Provider Enumeration Date:
08/17/2011