Provider First Line Business Practice Location Address:
19 21ST 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:
41071-2707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-581-6219
Provider Business Practice Location Address Fax Number:
859-491-0895
Provider Enumeration Date:
04/03/2007