Provider First Line Business Practice Location Address:
601 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41071-1986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-609-5315
Provider Business Practice Location Address Fax Number:
888-510-7888
Provider Enumeration Date:
02/23/2010