Provider First Line Business Practice Location Address:
6025 KENTUCKY DAM 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:
42003-9472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-898-4044
Provider Business Practice Location Address Fax Number:
270-898-4045
Provider Enumeration Date:
12/29/2005