Provider First Line Business Practice Location Address:
324 JAMES H PHILLIPS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42031-0083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-653-4620
Provider Business Practice Location Address Fax Number:
270-653-4585
Provider Enumeration Date:
01/07/2007