Provider First Line Business Practice Location Address:
2670 NEW HOLT RD STE C
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:
42001-7506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-575-1010
Provider Business Practice Location Address Fax Number:
270-575-1018
Provider Enumeration Date:
09/07/2012