Provider First Line Business Practice Location Address:
60 PHILLIPS BRANCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHELPS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41553-9061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-259-9101
Provider Business Practice Location Address Fax Number:
502-259-9109
Provider Enumeration Date:
09/29/2005