Provider First Line Business Practice Location Address:
601 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41071-1986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-344-1661
Provider Business Practice Location Address Fax Number:
859-344-8601
Provider Enumeration Date:
01/18/2012