Provider First Line Business Practice Location Address:
2605 KENTUCKY AVENUE, MED PARK 3
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-415-4820
Provider Business Practice Location Address Fax Number:
270-415-4819
Provider Enumeration Date:
05/23/2022