Provider First Line Business Practice Location Address:
3219 NORTH MAIN
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:
41702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-487-8657
Provider Business Practice Location Address Fax Number:
606-439-0931
Provider Enumeration Date:
03/26/2007