Provider First Line Business Practice Location Address:
12 E 5TH 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:
41071-1618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-578-3200
Provider Business Practice Location Address Fax Number:
859-534-2627
Provider Enumeration Date:
11/16/2016