Provider First Line Business Practice Location Address:
718 COLUMBIA 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:
41071-1837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-331-3292
Provider Business Practice Location Address Fax Number:
859-578-2864
Provider Enumeration Date:
02/05/2016