Provider First Line Business Practice Location Address:
257 COMBS RD STE 2
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:
41701-6851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-436-2308
Provider Business Practice Location Address Fax Number:
606-435-0080
Provider Enumeration Date:
11/22/2010