Provider First Line Business Practice Location Address:
117 3RD 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:
41701-2159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-233-1943
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2010