Provider First Line Business Practice Location Address:
2478 WOODLAND PLAZA
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:
40831-2569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-573-7200
Provider Business Practice Location Address Fax Number:
606-574-0406
Provider Enumeration Date:
07/17/2006