Provider First Line Business Practice Location Address:
208 N MAIN ST
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:
40701-1452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-258-8600
Provider Business Practice Location Address Fax Number:
606-258-8333
Provider Enumeration Date:
02/13/2015