Provider First Line Business Practice Location Address:
225 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
#405
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003-7914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-441-4750
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2005