Provider First Line Business Practice Location Address:
7617 UPPER JOHNS CREEK 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:
41553-8775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-835-9333
Provider Business Practice Location Address Fax Number:
606-835-9997
Provider Enumeration Date:
04/25/2006