Provider First Line Business Practice Location Address:
1040 CUMBERLAND FALLS HWY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CORBIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40701-2713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-523-0307
Provider Business Practice Location Address Fax Number:
606-523-9827
Provider Enumeration Date:
01/03/2007