Provider First Line Business Practice Location Address:
145 CITIZENS LN
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HAZARD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41701-1320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-435-7642
Provider Business Practice Location Address Fax Number:
606-436-5282
Provider Enumeration Date:
10/17/2014