Provider First Line Business Practice Location Address:
434 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:
41011-2342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-291-1121
Provider Business Practice Location Address Fax Number:
859-655-4882
Provider Enumeration Date:
09/30/2008