Provider First Line Business Practice Location Address:
701 WASHINGTON AVE
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:
41071-1926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-581-5631
Provider Business Practice Location Address Fax Number:
859-431-3189
Provider Enumeration Date:
11/08/2013