Provider First Line Business Practice Location Address:
192 BACON CREEK RD
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:
40701-8639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-526-1900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2026