Provider First Line Business Practice Location Address:
213 LOVERN ST
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
HAZARD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41701-1761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-438-5649
Provider Business Practice Location Address Fax Number:
606-714-0500
Provider Enumeration Date:
08/04/2008