Provider First Line Business Practice Location Address:
1317 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:
40701-2720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-584-8588
Provider Business Practice Location Address Fax Number:
865-584-3364
Provider Enumeration Date:
04/22/2008