Provider First Line Business Practice Location Address:
734 E 10TH 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:
41071-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-468-6730
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2007