Provider First Line Business Practice Location Address:
446 W CUMBERLAND GAP PKWY
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:
40701-4819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-523-1565
Provider Business Practice Location Address Fax Number:
606-526-4448
Provider Enumeration Date:
06/30/2009