Provider First Line Business Practice Location Address:
640 SCOTT ST
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:
41011-2416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-261-5852
Provider Business Practice Location Address Fax Number:
859-261-5853
Provider Enumeration Date:
12/15/2006