Provider First Line Business Practice Location Address:
200 MEDICAL CENTER DR STE 2D
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:
41701-9422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-487-7951
Provider Business Practice Location Address Fax Number:
606-487-7952
Provider Enumeration Date:
03/22/2006