Provider First Line Business Practice Location Address:
521 E. CUMBERLAND GAP PKWY.
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
CORBIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40701-2050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-261-2054
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2023