Provider First Line Business Practice Location Address:
423 SOUTH 28TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003-3865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-442-7181
Provider Business Practice Location Address Fax Number:
270-442-0113
Provider Enumeration Date:
12/22/2006