Provider First Line Business Practice Location Address:
1691 CLEAR FORK RD
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:
41701-7769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-785-4487
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/18/2008