Provider First Line Business Practice Location Address:
1406 SPRUCE ST
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:
40701-1957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-720-4199
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2026