Provider First Line Business Practice Location Address:
1610 CUMBERLAND FALLS HWY
Provider Second Line Business Practice Location Address:
STE 9
Provider Business Practice Location Address City Name:
CORBIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40701-2777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-258-7024
Provider Business Practice Location Address Fax Number:
606-258-7098
Provider Enumeration Date:
03/18/2009