Provider First Line Business Practice Location Address:
120 N COMMONWEALTH AVE STE 123&4
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:
40701-6472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-526-8603
Provider Business Practice Location Address Fax Number:
606-526-8607
Provider Enumeration Date:
11/19/2019