Provider First Line Business Practice Location Address:
1044 SCOTT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41011-3159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-291-1818
Provider Business Practice Location Address Fax Number:
859-291-6441
Provider Enumeration Date:
10/05/2006