Provider First Line Business Practice Location Address:
2605 KENTUCKY AVE
Provider Second Line Business Practice Location Address:
SUITE 402
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-366-7650
Provider Business Practice Location Address Fax Number:
270-443-7080
Provider Enumeration Date:
06/22/2007