Provider First Line Business Practice Location Address:
1707 FALLS ROAD PLAZA
Provider Second Line Business Practice Location Address:
SUITE U-4
Provider Business Practice Location Address City Name:
CORBIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-528-7336
Provider Business Practice Location Address Fax Number:
606-523-9189
Provider Enumeration Date:
06/19/2007