Provider First Line Business Practice Location Address:
13380 PHELPS 632 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-456-3446
Provider Business Practice Location Address Fax Number:
606-456-1943
Provider Enumeration Date:
07/30/2006