Provider First Line Business Practice Location Address:
18 COMMONWEALTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERLANGER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41018-1772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-727-3230
Provider Business Practice Location Address Fax Number:
859-727-9610
Provider Enumeration Date:
09/11/2006