Provider First Line Business Practice Location Address:
8554 KY 1232
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:
40701-6417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-261-7622
Provider Business Practice Location Address Fax Number:
606-261-7312
Provider Enumeration Date:
12/17/2018