Provider First Line Business Practice Location Address:
1700 ELMDALE 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:
42003-5517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-534-9173
Provider Business Practice Location Address Fax Number:
270-554-7126
Provider Enumeration Date:
09/10/2019