Provider First Line Business Practice Location Address:
9025 S US HIGHWAY 25
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:
40701-5092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-391-3155
Provider Business Practice Location Address Fax Number:
606-862-7797
Provider Enumeration Date:
11/29/2006