Provider First Line Business Practice Location Address:
30 S KY HIGHWAY 15
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:
41701-6029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-436-3128
Provider Business Practice Location Address Fax Number:
606-435-0664
Provider Enumeration Date:
12/08/2020