Provider First Line Business Practice Location Address:
211 ATLANTA ST
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:
42003-5509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-554-2328
Provider Business Practice Location Address Fax Number:
618-985-4652
Provider Enumeration Date:
10/21/2009