Provider First Line Business Practice Location Address:
22 COMMONWEALTH AVE STE 2
Provider Second Line Business Practice Location Address:
BOX 10
Provider Business Practice Location Address City Name:
ERLANGER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41018-1799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-240-3407
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2006