Provider First Line Business Practice Location Address:
2601 KENTUCKY AVE
Provider Second Line Business Practice Location Address:
STE 401
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003-3827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-444-8200
Provider Business Practice Location Address Fax Number:
270-444-8398
Provider Enumeration Date:
07/19/2006