Provider First Line Business Practice Location Address:
3217 CENTRAL AVE
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:
42001-4245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-442-6352
Provider Business Practice Location Address Fax Number:
270-443-3324
Provider Enumeration Date:
04/02/2007