Provider First Line Business Practice Location Address:
14949 N US HIGHWAY 25 E STE 3
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:
40701-6285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-280-4212
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2023