Provider First Line Business Practice Location Address:
1200 EAST MASTER STREET
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
CORBIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-528-5335
Provider Business Practice Location Address Fax Number:
606-528-5669
Provider Enumeration Date:
10/31/2006