Provider First Line Business Practice Location Address:
1707 CUMBERLAND FALLS HWY
Provider Second Line Business Practice Location Address:
SUITE U7
Provider Business Practice Location Address City Name:
CORBIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40701-2743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-528-9993
Provider Business Practice Location Address Fax Number:
606-528-5553
Provider Enumeration Date:
07/10/2012