Provider First Line Business Practice Location Address:
14949 N US HIGHWAY 25 E
Provider Second Line Business Practice Location Address:
STE. 4
Provider Business Practice Location Address City Name:
CORBIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40701-6285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-528-0305
Provider Business Practice Location Address Fax Number:
606-523-4368
Provider Enumeration Date:
06/13/2008