Provider First Line Business Practice Location Address:
14173 N US HIGHWAY 25 E
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:
40701-6183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-546-9722
Provider Business Practice Location Address Fax Number:
606-546-2106
Provider Enumeration Date:
12/27/2007