Provider First Line Business Practice Location Address:
415 N 7TH ST
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:
42001-1021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-443-3947
Provider Business Practice Location Address Fax Number:
270-217-4748
Provider Enumeration Date:
09/17/2009