Provider First Line Business Practice Location Address: 
1825 AIRPORT EXCHANGE BLVD
    Provider Second Line Business Practice Location Address: 
SUITE 100
    Provider Business Practice Location Address City Name: 
ERLANGER
    Provider Business Practice Location Address State Name: 
KY
    Provider Business Practice Location Address Postal Code: 
41018-3900
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
859-647-6228
    Provider Business Practice Location Address Fax Number: 
849-372-6350
    Provider Enumeration Date: 
12/06/2007