Provider First Line Business Practice Location Address:
507 US HIGHWAY 25 W
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:
40701-4525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-528-5822
Provider Business Practice Location Address Fax Number:
606-528-6369
Provider Enumeration Date:
04/03/2008