Provider First Line Business Practice Location Address:
52 CAROTHERS RD
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:
41071-2456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-291-2225
Provider Business Practice Location Address Fax Number:
859-291-2227
Provider Enumeration Date:
06/16/2006