Provider First Line Business Practice Location Address:
3894 E HIGHWAY 1223
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:
40701-5046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-528-2148
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2005