Provider First Line Business Practice Location Address:
200 MEDICAL CENTER DR STE 3N
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:
41701-9478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-439-6779
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2006