Provider First Line Business Practice Location Address:
1061 HUSBAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003-0204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-442-5020
Provider Business Practice Location Address Fax Number:
270-442-1973
Provider Enumeration Date:
09/05/2006