Provider First Line Business Practice Location Address:
1498 W CUMBERLAND GAP PKWY
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:
40701-5902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-280-7875
Provider Business Practice Location Address Fax Number:
833-974-2501
Provider Enumeration Date:
06/20/2024