Provider First Line Business Practice Location Address:
14892 N US HIGHWAY 25 E STE 11
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:
40701-6190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-727-2690
Provider Business Practice Location Address Fax Number:
606-727-2699
Provider Enumeration Date:
07/31/2023