Provider First Line Business Practice Location Address:
6525 U S HIGHWAY 60 W
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-217-9691
Provider Business Practice Location Address Fax Number:
270-575-9515
Provider Enumeration Date:
09/15/2006