Provider First Line Business Practice Location Address:
108 E 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORBIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40701-1422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-528-4380
Provider Business Practice Location Address Fax Number:
606-526-7258
Provider Enumeration Date:
01/17/2007