Provider First Line Business Practice Location Address:
206 S 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:
40701-1456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-528-0283
Provider Business Practice Location Address Fax Number:
606-528-8422
Provider Enumeration Date:
09/07/2006