Provider First Line Business Practice Location Address:
20 W 6TH 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:
41071-1825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-663-2261
Provider Business Practice Location Address Fax Number:
859-287-3392
Provider Enumeration Date:
10/09/2025