Provider First Line Business Practice Location Address:
30 W 8TH ST
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:
41071-1352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-292-3004
Provider Business Practice Location Address Fax Number:
859-292-3079
Provider Enumeration Date:
03/27/2007