Provider First Line Business Practice Location Address:
3524 PARK PLAZA RD
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:
42001-8900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-352-7530
Provider Business Practice Location Address Fax Number:
248-352-5189
Provider Enumeration Date:
09/30/2008