Provider First Line Business Practice Location Address:
131 NAHM ST
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42001-4362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-443-9285
Provider Business Practice Location Address Fax Number:
270-443-3044
Provider Enumeration Date:
09/16/2005