Provider First Line Business Practice Location Address:
81 BALL PARK ROAD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-573-8100
Provider Business Practice Location Address Fax Number:
606-573-8105
Provider Enumeration Date:
10/17/2006