Provider First Line Business Practice Location Address:
129 S HIGHWAY 1223
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:
40701-4641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-526-9636
Provider Business Practice Location Address Fax Number:
606-526-9590
Provider Enumeration Date:
01/18/2007