Provider First Line Business Practice Location Address:
1707CUMBERLAND FALLS HWY
Provider Second Line Business Practice Location Address:
UPPER LEVEL #1
Provider Business Practice Location Address City Name:
CORBIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40701-2744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-526-8856
Provider Business Practice Location Address Fax Number:
606-526-8902
Provider Enumeration Date:
05/15/2006