Provider First Line Business Practice Location Address:
48 PHILLIPS BRANCH RD
Provider Second Line Business Practice Location Address:
BOX 1085
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:
606-456-3477
Provider Business Practice Location Address Fax Number:
606-456-8246
Provider Enumeration Date:
11/04/2006