Provider First Line Business Practice Location Address:
HC 218
Provider Second Line Business Practice Location Address:
NORTHERN KENTUCKY UNIVERSITY NUNN DRIVE
Provider Business Practice Location Address City Name:
HIGHLAND HEIGHTS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-572-1489
Provider Business Practice Location Address Fax Number:
859-572-7956
Provider Enumeration Date:
06/10/2014