Provider First Line Business Practice Location Address:
3240 LONE OAK RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003-0370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-554-7661
Provider Business Practice Location Address Fax Number:
270-554-7683
Provider Enumeration Date:
10/10/2006