Provider First Line Business Practice Location Address:
545 LEBANON CHURCH RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003-9383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-554-6789
Provider Business Practice Location Address Fax Number:
270-554-3429
Provider Enumeration Date:
08/22/2007