Provider First Line Business Practice Location Address:
404 N WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42602-1312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-387-6623
Provider Business Practice Location Address Fax Number:
606-387-5521
Provider Enumeration Date:
08/05/2007