Provider First Line Business Practice Location Address:
208 E CUMBERLAND 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:
42602-1208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-745-9954
Provider Business Practice Location Address Fax Number:
888-244-5043
Provider Enumeration Date:
05/20/2026