Provider First Line Business Practice Location Address:
13369 N US HIGHWAY 25 E
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:
40701-6129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-523-1911
Provider Business Practice Location Address Fax Number:
606-523-2511
Provider Enumeration Date:
03/20/2007