Provider First Line Business Practice Location Address:
1200 MASTER 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:
40701-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-280-4000
Provider Business Practice Location Address Fax Number:
833-222-3797
Provider Enumeration Date:
09/30/2024