Provider First Line Business Practice Location Address:
281 N. COMMONWEALTH AVE.
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:
40701-0880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-528-1143
Provider Business Practice Location Address Fax Number:
606-523-1145
Provider Enumeration Date:
11/21/2006