Provider First Line Business Practice Location Address:
8699 S US HIGHWAY 25
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:
40701-4973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-229-4647
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2022