Provider First Line Business Practice Location Address:
212 LEVASSOR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41014-1734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-392-3175
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2026