Provider First Line Business Practice Location Address:
383 CORBIN CENTER DRIVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-529-2919
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2007